Healthcare Provider Details

I. General information

NPI: 1881273258
Provider Name (Legal Business Name): EMRAH GUMUSGOZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3895 N O CONNOR RD # 3895
IRVING TX
75062-7629
US

IV. Provider business mailing address

3895 N O CONNOR RD # 3895
IRVING TX
75062-7629
US

V. Phone/Fax

Practice location:
  • Phone: 203-747-4896
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036170613
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: