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General NPI Number Information
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NPI Number | 1386629210
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Entity Type | Individual
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Provider Name | DANIEL E GORMLEY MD
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Gender | Male
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 412 W CARROLL AVE STE 207
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City | GLENDORA
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State | CA
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Zip | 91741-4240
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Country | US
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Telephone | 626-963-7684
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Fax | 626-963-0575
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Provider Business Mailing Address
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Address Line | 412 W CARROLL AVE STE 207
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City | GLENDORA
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State | CA
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Zip | 91741-4240
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Country | US
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Telephone | 626-963-7684
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Fax | 626-963-0575
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A21148
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A21148
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | A21148
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | A21148
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License Number State | CA
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