Provider Demographics
NPI:1922036375
Name:GORMAN, JACK B (DPM)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:B
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-4516
Mailing Address - Country:US
Mailing Address - Phone:215-672-3222
Mailing Address - Fax:215-672-6634
Practice Address - Street 1:399 YORK RD
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-4516
Practice Address - Country:US
Practice Address - Phone:215-672-3222
Practice Address - Fax:215-672-6634
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001284L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0505452Medicaid
PA31851AOtherKEYSTONE MERCY
PA048077OtherHIGHMARK BLUE SHEILD
PAT23784OtherHEALTH PARTNERS
PA0023085000OtherKEYSTONE BLUE SHEILD
PAT23784OtherHEALTH PARTNERS
PAT27384Medicare UPIN
PA0505452Medicaid