Healthcare Provider Details

I. General information

NPI: 1285551549
Provider Name (Legal Business Name): JAMES GORRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 TOWNSHIP ROAD 262
BLOOMINGDALE OH
43910-6806
US

IV. Provider business mailing address

837 TOWNSHIP ROAD 262
BLOOMINGDALE OH
43910-6806
US

V. Phone/Fax

Practice location:
  • Phone: 315-804-9026
  • Fax:
Mailing address:
  • Phone: 315-804-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010372RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: