Provider Demographics
NPI:1437290624
Name:JAMES F GORMAN MD
Entity Type:Organization
Organization Name:JAMES F GORMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-482-6800
Mailing Address - Street 1:1690 WOODLANDS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-4045
Mailing Address - Country:US
Mailing Address - Phone:419-861-5430
Mailing Address - Fax:419-861-7611
Practice Address - Street 1:5705 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1875
Practice Address - Country:US
Practice Address - Phone:419-482-6800
Practice Address - Fax:419-482-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35028962208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0141944Medicare PIN