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NPI Code Detail

MEDICARE: RICHARD JOHN GORMAN MD

MEDICARE: RICHARD JOHN GORMAN 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
12084N0402XNeurology with Special Qualifications in Child Neurology Physician10158MS

General Provider Information

NPI Number : 1386147874
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHARD JOHN GORMAN MD
Provider Business Mailing Address
First Line : 1903 PASS RD STE A
Second Line :
City : BILOXI
State : MS
Zip : 39531-4103
Country : US
Telephone Number : 228-436-1649
Fax Number : 228-436-1664
Provider Business Practice Location Address
First Line : 1903 PASS RD STE A
Second Line :
City : BILOXI
State : MS
Zip : 39531-4103
Country : US
Telephone Number : 228-436-1649
Fax Number : 228-436-1664
Authorized Official
Title or Position : SECT
Name : TERESA CARROLL
Credential :
Telephone Number : 228-436-1649
Provider Enumeration Date : 03/12/2018
Last Update Date : 03/12/2018

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