Provider Demographics
NPI:1184722753
Name:THORP, GORMAN M (MD)
Entity type:Individual
Prefix:
First Name:GORMAN
Middle Name:M
Last Name:THORP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4220
Mailing Address - Fax:325-672-8292
Practice Address - Street 1:1201 N 18TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2932
Practice Address - Country:US
Practice Address - Phone:325-793-3100
Practice Address - Fax:325-673-3195
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2063207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
80671SOtherBCBS
060055530OtherRAILROAD MEDICARE
125495100OtherFIRSTCARE
TX138567605Medicaid
060055530OtherRAILROAD MEDICARE
B26968Medicare UPIN
125495100OtherFIRSTCARE
TX138567605Medicaid