Provider Demographics
NPI:1295735769
Name:GORMAN, PATRICK D (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
Last Name:GORMAN
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 1:2985 CORTEZ AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-2985
Mailing Address - Country:US
Mailing Address - Phone:208-523-3373
Mailing Address - Fax:208-523-8746
Practice Address - Street 1:2985 CORTEZ AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-2985
Practice Address - Country:US
Practice Address - Phone:208-523-3373
Practice Address - Fax:208-523-8746
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8388207RC0000X
MDF86110207RC0000X
IDM-8388207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1103740OtherCIGNA
WY118682500OtherEDS CONSULTEC, INC.
46763OtherBC OF IDAHO
WY118682500Medicaid
000010136417OtherBS OF IDAHO
060067151OtherRAILROAD MEDICARE
ID806232000Medicaid
IDF86110Medicare UPIN
WY118682500Medicaid
1103740OtherCIGNA