Provider Demographics
NPI:1336103365
Name:GORE, HERMAN CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:CLARK
Last Name:GORE
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 1:900 COX RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3460
Mailing Address - Country:US
Mailing Address - Phone:704-864-3300
Mailing Address - Fax:704-864-3300
Practice Address - Street 1:900 COX RD
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3460
Practice Address - Country:US
Practice Address - Phone:704-864-3300
Practice Address - Fax:704-864-2002
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900850174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891225XMedicaid
NC1225XOtherBLUE CROSS BLUE SHEILD
SCN00851Medicaid
NC1225XOtherBLUE CROSS BLUE SHEILD
NCH00789Medicare UPIN