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NPI Code Detail

MEDICARE: EDWARD KIRKHAM GORE MD

MEDICARE: EDWARD KIRKHAM GORE MD
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
1207Q00000XFamily Medicine Physician04981MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11194833400OTHERMSGROUP NPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205802584
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD KIRKHAM GORE MD
Provider Business Mailing Address
First Line : PO BOX 432
Second Line :
City : HOUSTON
State : MS
Zip : 38851-0432
Country : US
Telephone Number : 662-456-2037
Fax Number : 662-456-1006
Provider Business Practice Location Address
First Line : 1002 E MADISON ST
Second Line :
City : HOUSTON
State : MS
Zip : 38851-2417
Country : US
Telephone Number : 662-456-2037
Fax Number : 662-456-1006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 06/20/2018

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