Provider Demographics
NPI:1578582755
Name:GORE, RUFUS WADE (MD)
Entity Type:Individual
Prefix:
First Name:RUFUS
Middle Name:WADE
Last Name:GORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1059
Mailing Address - Country:US
Mailing Address - Phone:760-568-2684
Mailing Address - Fax:760-837-2241
Practice Address - Street 1:41990 COOK ST STE 302
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6101
Practice Address - Country:US
Practice Address - Phone:760-895-4123
Practice Address - Fax:760-895-4025
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63651207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF31827Medicare UPIN
CA0G636510Medicare PIN