Provider Demographics
NPI:1942366745
Name:GOORE, MYRTLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRTLE
Middle Name:E
Last Name:GOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3184 PARLIAMENT CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-7271
Mailing Address - Country:US
Mailing Address - Phone:334-244-1161
Mailing Address - Fax:334-244-8772
Practice Address - Street 1:3184 PARLIAMENT CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-7271
Practice Address - Country:US
Practice Address - Phone:334-244-1161
Practice Address - Fax:334-244-8772
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL4149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51010321OtherBLUE CROSS
AL000010321Medicaid
AL51010321OtherBLUE CROSS
ALE52014Medicare UPIN