Provider Demographics
NPI:1750438735
Name:GORME, NEIL
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:GORME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-795-4120
Mailing Address - Fax:713-795-4123
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-795-4120
Practice Address - Fax:713-795-4123
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00776EMedicare PIN