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General NPI Number Information
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NPI Number | 1003136987
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Entity Type | Individual
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Provider Name | ETHAN MCCALEB GORE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2010
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 8333 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32514-6050
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Country | US
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Telephone | 850-474-8353
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Fax | 850-474-8504
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Provider Business Mailing Address
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Address Line | 8333 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32514-6050
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Country | US
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Telephone | 850-474-8100
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Fax | 850-474-8083
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME127830
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License Number State | FL
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