Provider Demographics
NPI:1104926500
Name:GORMAN, STEVEN P (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:P
Last Name:GORMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:78150 CALLE TAMPICO
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253
Mailing Address - Country:US
Mailing Address - Phone:760-564-1886
Mailing Address - Fax:760-564-2558
Practice Address - Street 1:78150 CALLE TAMPICO
Practice Address - Street 2:SUITE 100
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253
Practice Address - Country:US
Practice Address - Phone:760-564-1886
Practice Address - Fax:760-564-2558
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG083973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G839730Medicaid
G38311Medicare UPIN
CA00G839730Medicare ID - Type Unspecified