Healthcare Provider Details

I. General information

NPI: 1932367588
Provider Name (Legal Business Name): CHERYL A.GORE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 LAFAYETTE ST
BELLAIRE TX
77401-5622
US

IV. Provider business mailing address

4307 LAFAYETTE ST
BELLAIRE TX
77401-5622
US

V. Phone/Fax

Practice location:
  • Phone: 713-669-0188
  • Fax:
Mailing address:
  • Phone: 713-669-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberK5968
License Number StateTX

VIII. Authorized Official

Name: CHERYL ANN GORE
Title or Position: PRESIDENT
Credential: M.D., M.B.A.
Phone: 713-669-0188