Provider Demographics
NPI:1093842783
Name:MICHAEL S. GORBY, M.D.P.A.
Entity Type:Organization
Organization Name:MICHAEL S. GORBY, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-729-8328
Mailing Address - Street 1:1021 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-5041
Mailing Address - Country:US
Mailing Address - Phone:903-729-8328
Mailing Address - Fax:903-729-5640
Practice Address - Street 1:1021 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-5041
Practice Address - Country:US
Practice Address - Phone:903-729-8328
Practice Address - Fax:903-729-5640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00014HMedicare PIN