Provider Demographics
NPI:1578672648
Name:GORAN, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:GORAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8124
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-747-2075
Mailing Address - Fax:314-454-5042
Practice Address - Street 1:12634 OLIVE BLVD
Practice Address - Street 2:DIV IM GASTROENTEROLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6337
Practice Address - Country:US
Practice Address - Phone:314-747-2066
Practice Address - Fax:314-878-3022
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MOR7799207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201851128Medicaid
MO927614489Medicare ID - Type Unspecified
A10167Medicare UPIN