Provider Demographics
NPI:1609840966
Name:GILMORE, GEORGE E (PA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:GILMORE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SANDLER DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2536
Mailing Address - Country:US
Mailing Address - Phone:303-919-4503
Mailing Address - Fax:720-887-4663
Practice Address - Street 1:103 SANDLER DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2536
Practice Address - Country:US
Practice Address - Phone:303-919-4503
Practice Address - Fax:720-887-4663
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0788207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91433045Medicaid
CO91433045Medicaid
CO803452Medicare ID - Type Unspecified