Provider Demographics
NPI:1790124113
Name:GORE, WILLIAM STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STANLEY
Last Name:GORE
Suffix:
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 1:570 BEECHWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:HEMPHILL
Mailing Address - State:TX
Mailing Address - Zip Code:75948-6615
Mailing Address - Country:US
Mailing Address - Phone:409-579-3070
Mailing Address - Fax:
Practice Address - Street 1:570 BEECHWOOD LOOP
Practice Address - Street 2:
Practice Address - City:HEMPHILL
Practice Address - State:TX
Practice Address - Zip Code:75948-6615
Practice Address - Country:US
Practice Address - Phone:409-579-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1857207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology