Provider Demographics
NPI:1497721948
Name:GORMLEY, THOMAS S (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:S
Last Name:GORMLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2545 S DON ROSER DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9107
Mailing Address - Country:US
Mailing Address - Phone:575-522-7880
Mailing Address - Fax:575-522-7226
Practice Address - Street 1:2545 S DON ROSER DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9107
Practice Address - Country:US
Practice Address - Phone:575-522-7880
Practice Address - Fax:575-522-7226
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM98-61208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88579751Medicaid
G64753Medicare UPIN
NM88579751Medicaid