Provider Demographics
NPI:1184024572
Name:GORSUCH, JOHN (AP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GORSUCH
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6741
Mailing Address - Country:US
Mailing Address - Phone:407-738-7412
Mailing Address - Fax:
Practice Address - Street 1:4121 NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6741
Practice Address - Country:US
Practice Address - Phone:407-738-7412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3470171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist