Provider Demographics
NPI:1124044771
Name:GORREY, PURUSHOTHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PURUSHOTHAM
Middle Name:
Last Name:GORREY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 ROY CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9485
Mailing Address - Country:US
Mailing Address - Phone:606-435-1708
Mailing Address - Fax:606-435-2445
Practice Address - Street 1:509 N BRIGHTLEAF BLVD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-938-7189
Practice Address - Fax:919-934-1761
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2022-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40269207P00000X
NC2011-01467207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64129406Medicaid
KY40269OtherMD LICENSURE
KY64129406Medicaid
KY40269OtherMD LICENSURE