Doctor Name: | DR. NICHOLAS PARENT GORHAM |
NPI Number: | 1942521026 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 01070713A |
Business Practice Address: | 4-2 Sbct, Surgeon Cell Jblm, WA - 98433 |
Business Phone Number: | 2539663576 |
Business Fax Number: | |
Mailing Address: | 908 17th Ave, SEATTLE |
State: | WA |
Postal Code: | 981224627 |
Phone Number: | 2108676412 |
Fax Number: | |
NPI Enumeration Date: | 06/12/2010 |
NPI Last Update Date: | 02/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01070713A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |