Provider Demographics
NPI:1578777132
Name:GORE, LARRY BROOKS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BROOKS
Last Name:GORE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4868
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-9820
Mailing Address - Country:US
Mailing Address - Phone:910-575-3857
Mailing Address - Fax:
Practice Address - Street 1:850 SUNSET BLVD N
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-4262
Practice Address - Country:US
Practice Address - Phone:910-579-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1436231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist