Provider Demographics
NPI:1356628515
Name:GORE, PAULA SUMMER (LMT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUMMER
Last Name:GORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2383 CAMINO CAPITAN
Mailing Address - Street 2:APT #1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6442
Mailing Address - Country:US
Mailing Address - Phone:505-220-0633
Mailing Address - Fax:
Practice Address - Street 1:2383 CAMINO CAPITAN
Practice Address - Street 2:APT #1
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6442
Practice Address - Country:US
Practice Address - Phone:505-220-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist