Provider Demographics
NPI:1164083010
Name:JESSE GORLEY, M.D., PLLC
Entity Type:Organization
Organization Name:JESSE GORLEY, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-386-9041
Mailing Address - Street 1:1411 9TH ST.
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4302
Mailing Address - Country:US
Mailing Address - Phone:940-386-9041
Mailing Address - Fax:940-448-3298
Practice Address - Street 1:1411 9TH ST.
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4302
Practice Address - Country:US
Practice Address - Phone:940-386-9041
Practice Address - Fax:940-448-3298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9322OtherTEXAS MEDICAL BOARD
TX1346452760Medicaid
TX1346452760Medicaid
TXXG5566128OtherDEA