Gorham, Jennie L

Gorham, Jennie L is an individual health care provider with primary practice located at 3555 S National Ave #302, Springfield MO 65807-7310. She recently has only one registered license in Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, which is considered as her primary health care specialty. Gorham, Jennie L can be contacted via phone (417) 269-6868.

Contact Information

Primary practice address
3555 S National Ave #302 Springfield MO 65807-7310
Phone: (417) 269-6868
Fax: (417) 269-6865
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X DO100997 Missouri

Profile Details

NPI number 1730166257
LBN Legal business name Gorham, Jennie L
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2005
Last updated Jan 21st, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730166257 NPPES
Missouri MEDICAID 1730166257

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