Provider Demographics
NPI:1982766705
Name:GORE, MALHAR S (MD)
Entity Type:Individual
Prefix:
First Name:MALHAR
Middle Name:S
Last Name:GORE
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 2027
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52244-2027
Mailing Address - Country:US
Mailing Address - Phone:319-339-3541
Mailing Address - Fax:319-358-2737
Practice Address - Street 1:510 W MAIN ST
Practice Address - Street 2:#A
Practice Address - City:SOLON
Practice Address - State:IA
Practice Address - Zip Code:52333-9764
Practice Address - Country:US
Practice Address - Phone:319-624-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4072074Medicaid
IA18932OtherBCBS
IA4072074Medicaid