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General NPI Number Information
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NPI Number | 1083724215
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Entity Type | Organization
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Legal Business Name | DEBRA S GORIN MD PC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1361 CAMBRIDGE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4208
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Country | US
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Telephone | 208-535-8549
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Fax | 208-528-8109
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Provider Business Mailing Address
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Address Line | 1361 CAMBRIDGE DR
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City | IDAHO FALLS
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State | ID
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Zip | 83401-4208
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Country | US
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Telephone | 208-535-8549
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Fax | 208-528-8109
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBRA S GORIN
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Credential | MD PC
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Telephone | 208-535-8549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M-9459
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License Number State | ID
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