Provider Demographics
NPI:1225160427
Name:GOROSPE, EMMANUEL CRUZ (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:CRUZ
Last Name:GOROSPE
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 1:1250 E CLIFF DR STE 1C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4827
Mailing Address - Country:US
Mailing Address - Phone:915-351-7200
Mailing Address - Fax:915-351-7201
Practice Address - Street 1:1250 E CLIFF DR STE 1C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4827
Practice Address - Country:US
Practice Address - Phone:915-351-7200
Practice Address - Fax:915-351-7201
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9362207RG0100X
MN53333207RG0100X
MN104872207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365134101Medicaid
TX531333YMT1Medicare UPIN
MN100000845Medicare PIN
MNP00849660OtherRAILROAD MEDICARE