Provider Demographics
NPI:1699735480
Name:SCHORR, M GARY (MD)
Entity type:Individual
Prefix:
First Name:M
Middle Name:GARY
Last Name:SCHORR
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 1:715 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-3625
Mailing Address - Country:US
Mailing Address - Phone:561-364-2626
Mailing Address - Fax:561-364-2029
Practice Address - Street 1:715 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3625
Practice Address - Country:US
Practice Address - Phone:561-364-2626
Practice Address - Fax:561-364-2029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41922174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD34096Medicare UPIN
FL61275ZMedicare ID - Type Unspecified