MEDICARE: RICHARD ALLEN GORMAN II 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	ME158434	FL

General Provider Information

NPI Number	:	1598392706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ALLEN GORMAN II MD

Provider Business Mailing Address
First Line	:	3106 W BAY TO BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7212
Country	:	US
Telephone Number	:	813-692-1802
Fax Number	:	833-428-4407

Provider Business Practice Location Address
First Line	:	3106 W BAY TO BAY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-7212
Country	:	US
Telephone Number	:	813-692-1802
Fax Number	:	833-428-4407

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2020
Last Update Date	:	08/11/2025

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