Healthcare Provider Details

I. General information

NPI: 1922036375
Provider Name (Legal Business Name): JACK B. GORMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 YORK RD
WARMINSTER PA
18974-4516
US

IV. Provider business mailing address

399 YORK RD
WARMINSTER PA
18974-4516
US

V. Phone/Fax

Practice location:
  • Phone: 215-672-3222
  • Fax: 215-672-6634
Mailing address:
  • Phone: 215-672-3222
  • Fax: 215-672-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberSC001284L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: