Doctor Name: | JEREMY P. GORSUCH |
NPI Number: | 1023387834 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 175 Meadowbrook Lane Duncansville, PA - 16635 |
Business Phone Number: | 8146930300 |
Business Fax Number: | 8146961882 |
Mailing Address: | Po Box 909, 175 Meadowbrook Lane DUNCANSVILLE |
State: | PA |
Postal Code: | 16635 |
Phone Number: | 8146930300 |
Fax Number: | 8146961882 |
NPI Enumeration Date: | 12/22/2011 |
NPI Last Update Date: | 12/22/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |