Provider Demographics
NPI:1477548196
Name:GORE, THOMAS ORVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ORVILLE
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 1:4711 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3218
Mailing Address - Country:US
Mailing Address - Phone:806-791-2024
Mailing Address - Fax:806-792-6156
Practice Address - Street 1:3302 34TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-3232
Practice Address - Country:US
Practice Address - Phone:806-791-2024
Practice Address - Fax:806-792-6156
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF66822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB87919Medicare UPIN
TX00D77HMedicare ID - Type Unspecified