Healthcare Provider Details

I. General information

NPI: 1124006663
Provider Name (Legal Business Name): ALAN G. GORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 W 5TH AVE SUITE 225
COLUMBUS OH
43204-4899
US

IV. Provider business mailing address

2323 W 5TH AVE SUITE 225
COLUMBUS OH
43204-4899
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-6420
  • Fax: 614-224-6423
Mailing address:
  • Phone: 614-224-6420
  • Fax: 614-224-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35-065602
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: