Provider Demographics
NPI:1376576017
Name:GORMAN, VALERIE JEAN (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:JEAN
Last Name:GORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 W JEFFERSON ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-2277
Mailing Address - Country:US
Mailing Address - Phone:972-923-1457
Mailing Address - Fax:972-923-1304
Practice Address - Street 1:1505 W JEFFERSON ST
Practice Address - Street 2:SUITE 165
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2277
Practice Address - Country:US
Practice Address - Phone:972-923-1457
Practice Address - Fax:972-923-1304
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8353208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165952602Medicaid
TX8BR114OtherBCBS
TX8M3095OtherBCBS
TX165948402Medicaid
TX8L5639Medicare PIN
TX8BR114OtherBCBS
TX8M3095OtherBCBS
TX165952602Medicaid