Provider Demographics
NPI:1598834228
Name:GORSUCH, PAUL L JR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:L
Last Name:GORSUCH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:#101
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-761-3181
Mailing Address - Fax:406-761-3192
Practice Address - Street 1:401 15TH AVE S
Practice Address - Street 2:#101
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-761-3181
Practice Address - Fax:406-761-3192
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6394207T00000X
CA45187207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0079781Medicaid
MT0079781Medicaid
9707Medicare ID - Type Unspecified
MTM000009707Medicare PIN