Provider Demographics
NPI:1528073996
Name:GORES, GUIDO J JR (MD)
Entity type:Individual
Prefix:DR
First Name:GUIDO
Middle Name:J
Last Name:GORES
Suffix:JR
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 1:909 HYDE ST STE 125
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-4832
Mailing Address - Country:US
Mailing Address - Phone:415-771-4366
Mailing Address - Fax:415-771-6412
Practice Address - Street 1:909 HYDE ST STE 125
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4832
Practice Address - Country:US
Practice Address - Phone:415-771-4366
Practice Address - Fax:415-771-6412
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG612540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0076920Medicaid
CALAB93636FOtherMEDICAL CLIA
CAE37913Medicare UPIN
CA00G612540Medicare PIN