Provider Demographics
NPI:1437113388
Name:GORE, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:GORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 S COTTAGE GROVE AVE
Mailing Address - Street 2:APT 602
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4140
Mailing Address - Country:US
Mailing Address - Phone:312-326-3907
Mailing Address - Fax:
Practice Address - Street 1:3440 S COTTAGE GROVE AVE
Practice Address - Street 2:APT 602
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4140
Practice Address - Country:US
Practice Address - Phone:312-326-3907
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36114798207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine