Provider Demographics
NPI:1487823944
Name:GORGE UROLOGY PC
Entity Type:Organization
Organization Name:GORGE UROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GINGRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-296-2201
Mailing Address - Street 1:1805 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3365
Mailing Address - Country:US
Mailing Address - Phone:541-296-2201
Mailing Address - Fax:541-296-1237
Practice Address - Street 1:1805 E 19TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3365
Practice Address - Country:US
Practice Address - Phone:541-296-2201
Practice Address - Fax:541-296-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132809Medicare PIN