Healthcare Provider Details

I. General information

NPI: 1760547855
Provider Name (Legal Business Name): JOSEPH P. GORMLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 PLEASANT VALLEY RD
WEST BEND WI
53095-9274
US

IV. Provider business mailing address

3200 PLEASANT VALLEY RD
WEST BEND WI
53095-9274
US

V. Phone/Fax

Practice location:
  • Phone: 262-836-7301
  • Fax: 262-836-7301
Mailing address:
  • Phone: 262-836-7301
  • Fax: 262-836-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number75347
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: