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NPI Code Detail

MEDICARE: LINDA S GORE PA

MEDICARE: LINDA S GORE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant98CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144218595
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDA S GORE PA
Provider Business Mailing Address
First Line : 1345 PLAZA CT N STE 1A
Second Line :
City : LAFAYETTE
State : CO
Zip : 80026-2832
Country : US
Telephone Number : 303-665-3036
Fax Number :
Provider Business Practice Location Address
First Line : 2525 13TH STREET
Second Line :
City : BOULDER
State : CO
Zip : 80304-4104
Country : US
Telephone Number : 303-449-6050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2005
Last Update Date : 07/17/2013

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Directions to “ LINDA S GORE PA” Practice Location

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