Provider Demographics
NPI:1851046460
Name:GORE, CURTIS L (NP AND PA)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
Last Name:GORE
Suffix:
Gender:M
Credentials:NP AND PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 STELZER RD LOT 214
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-5720
Mailing Address - Country:US
Mailing Address - Phone:614-687-0271
Mailing Address - Fax:
Practice Address - Street 1:2740 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4903
Practice Address - Country:US
Practice Address - Phone:614-687-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health