Provider Demographics
NPI:1073762894
Name:GORMAN MOAPA VALLEY FAMILY PRATICE PLLC MICHAEL J GORMAN SOLE MBR
Entity Type:Organization
Organization Name:GORMAN MOAPA VALLEY FAMILY PRATICE PLLC MICHAEL J GORMAN SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-398-3621
Mailing Address - Street 1:PO BOX 357
Mailing Address - Street 2:
Mailing Address - City:LOGANDALE
Mailing Address - State:NV
Mailing Address - Zip Code:89021-0357
Mailing Address - Country:US
Mailing Address - Phone:702-398-3621
Mailing Address - Fax:702-398-3639
Practice Address - Street 1:1925 WHIPPLE AVE
Practice Address - Street 2:STE 30
Practice Address - City:LOGANDALE
Practice Address - State:NV
Practice Address - Zip Code:89021
Practice Address - Country:US
Practice Address - Phone:702-398-3621
Practice Address - Fax:702-398-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1423207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty