Provider Demographics
NPI:1215035365
Name:GORE, DAVID LEON JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEON
Last Name:GORE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 PHILIP ROTH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1393
Practice Address - Country:US
Practice Address - Phone:757-873-6434
Practice Address - Fax:757-873-1882
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-11-27
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Provider Licenses
StateLicense IDTaxonomies
VA0101036761208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery