Healthcare Provider Details

I. General information

NPI: 1891817060
Provider Name (Legal Business Name): PAUL ANTHONY GORE JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 CAMPUS CENTER DR UNIVERSITY OF UTAH
SALT LAKE CITY UT
84112-9299
US

IV. Provider business mailing address

2786 MCKINLEY CIR
TAYLORSVILLE UT
84084-5303
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7233
  • Fax:
Mailing address:
  • Phone: 801-581-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6252651-2501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: