Provider Demographics
NPI:1801194626
Name:GORGES, ANNA (RD)
Entity Type:Individual
Prefix:MISS
First Name:ANNA
Middle Name:
Last Name:GORGES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 SAINT GALLEN LANE
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067
Mailing Address - Country:US
Mailing Address - Phone:214-998-0709
Mailing Address - Fax:
Practice Address - Street 1:1901 GATEWAY DR
Practice Address - Street 2:175
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2471
Practice Address - Country:US
Practice Address - Phone:214-596-9302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81166133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered