Provider Demographics
NPI:1386853406
Name:GORMAN, PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:GORMAN
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 1:570 EL CAMINO REAL
Mailing Address - Street 2:SUITE 260
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1200
Mailing Address - Country:US
Mailing Address - Phone:650-556-0200
Mailing Address - Fax:650-556-0201
Practice Address - Street 1:570 EL CAMINO REAL
Practice Address - Street 2:SUITE 260
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1200
Practice Address - Country:US
Practice Address - Phone:650-556-0200
Practice Address - Fax:650-556-0201
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69764208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH58657Medicare UPIN