Provider Demographics
NPI:1013008150
Name:GOORIS, PAUL RAYMOND (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RAYMOND
Last Name:GOORIS
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:10001 COORS BYP NW
Mailing Address - Street 2:APT #1118
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4024
Mailing Address - Country:US
Mailing Address - Phone:505-834-7413
Mailing Address - Fax:505-834-7517
Practice Address - Street 1:110 SHEEP SPRINGS WAY
Practice Address - Street 2:
Practice Address - City:JEMEZ PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87114
Practice Address - Country:US
Practice Address - Phone:505-834-7413
Practice Address - Fax:505-834-7517
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM84-PA005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91314Medicaid
NMQ69115Medicare UPIN