Provider Demographics
NPI:1417125766
Name:GORE, SAMUEL PAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PAYTON
Last Name:GORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2800 GRAVIER ST.
Mailing Address - Street 2:ORLEANS PARISH CRIMINAL SHERIFF'S OFFICE
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-827-8528
Mailing Address - Fax:504-827-8859
Practice Address - Street 1:2800 GRAVIER ST
Practice Address - Street 2:ORLEANS PARISH CRIMINAL SHERIFF'S OFFICE
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7330
Practice Address - Country:US
Practice Address - Phone:504-827-8528
Practice Address - Fax:504-827-8859
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13204-R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1556921Medicaid
LAH05782Medicare UPIN