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General NPI Number Information
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NPI Number | 1932213204
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Entity Type | Individual
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Provider Name | MARK C. GORRIE DO
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 714 N. SENATE AVE SUITE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3297
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Country | US
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Telephone | 317-944-1837
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Fax | 317-715-6415
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVENUE SUITE 130
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone | 317-963-0860
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 36113813
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 02003492A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | OS18237
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License Number State | FL
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