Healthcare Provider Details

I. General information

NPI: 1154543494
Provider Name (Legal Business Name): MONICA R GORCOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA C RAPOSO

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E BRADFORD PKWY
SPRINGFIELD MO
65804-4264
US

IV. Provider business mailing address

1300 E BRADFORD PKWY
SPRINGFIELD MO
65804-4264
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5000
  • Fax: 417-761-5011
Mailing address:
  • Phone: 417-761-5000
  • Fax: 417-761-5011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2022040454
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: