Healthcare Provider Details

I. General information

NPI: 1356938088
Provider Name (Legal Business Name): J. D. GLOOR, M. D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 POST RD STE 103
NORTH KINGSTOWN RI
02852-3246
US

IV. Provider business mailing address

7260 POST RD STE 103
NORTH KINGSTOWN RI
02852-3246
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-8200
  • Fax: 401-294-8222
Mailing address:
  • Phone: 401-294-8200
  • Fax: 401-294-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA K GLOOR
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 401-294-8200