JIM F GORMAN (NPI# 1255483079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255483079 |
| Entity Type | Individual |
| Full Name | JIM F GORMAN |
| Credential | MC |
| Practice Address |
530 East Riley Drive Avondale AZ 85323 |
| Practice Telephone | 6238327407 |
| Practice Fax Number | 6239321884 |
| Mailing Telephone | 6238327407 |
| Mailing Fax Number | 6239321884 |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-07-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TS0200X |
Psychologist Specialization: School |
AZ | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | PROVIDER ID NUMBER | 588668 | 01 |
| AZ | AHCCCS MEMBERS | 594722 | 01 |
| Street Address |
530 EAST RILEY DRIVE |
| City | AVONDALE |
| State | AZ |
| Zip Code | 85323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932663994 | Bridgewater Avondale Operations, LLC | Assisted Living Facility | 295 E Van Buren Street, Avondale, AZ 85323 | 2019-01-24 |
| 1104309152 | Carlos Sifuentes | Physical Therapist | 10750 W Mcdowell Rd., Ste. B-210, Avondale, AZ 85323 | 2018-09-14 |
| 1225534688 | Dayna Sue Kaepp | Registered Nurse | 3300 N. Santa Fe Trail, Avondale, AZ 85323 | 2018-04-04 |
| 1407376700 | Amanda Lynn Radcliffe | Nurse Practitioner | 824 N. 99th Ave Ste 108, Avondale, AZ 85323 | 2017-06-27 |
| 1093253361 | Aquatic-n-writing Rehad | Home Health | 12355 West Cocopah Street, Avondale, AZ 85323 | 2017-02-07 |
| 1750838348 | Annette A Alvarez | Specialist/Technologist | 295 W Western Avenue, Avondale, AZ 85323 | 2016-09-01 |
| 1649726886 | Michelle R Dotson | Contractor | 12115 W Van Buren St Apt 1924, Avondale, AZ 85323 | 2016-08-28 |
| 1619370756 | Amanda Mann | Physical Therapy Assistant | 12804 West Hildalgo, Avondale, AZ 85323 | 2014-10-03 |
| 1326459306 | Ma Caubalejo | Physical Therapist | 350 East La Canada Blvd, Avondale, AZ 85323 | 2014-05-13 |
| 1093139545 | Mark Salvador | Physical Therapy Assistant | 11722 W. Mountain View Dr., Avondale, AZ 85323 | 2014-02-04 |
| Find all providers in zip 85323 | ||||
| Taxonomy Code | 103TS0200X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | School |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306076526 | Stacy Anderson Taouil | Psychologist | 1406 N Central Ave, Avondale, AZ 85323-1312 | 2009-07-22 |
| 1285856302 | Mark Hedges | Psychologist | 10762 W Windsor Ave, Avondale, AZ 85323-5830 | 2007-05-02 |
| 1194946665 | Theodore Jon Miron | Psychologist | 3542 N 130th Dr, Avondale, AZ 85323-6681 | 2007-05-01 |
| 1295956076 | Wendy Krisik | Psychologist | 11148 W Laurelwood Ln, Avondale, AZ 85323-3931 | 2007-05-01 |
| 1356644405 | Sarah Opuroku | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2010-12-13 |
| 1235442724 | Shaunna Jean Sukey | Psychologist | 1406 N Central Ave, Avondale, AZ 85323-1312 | 2010-07-26 |
| 1083620561 | Stephen Clay Neal Jr. | Psychologist | 45 S 3rd Ave, Avondale, AZ 85323-2264 | 2006-08-01 |
| 1124032693 | Nancy R. Schaeffer | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2006-07-28 |
| 1124032131 | Jim Howard | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2006-07-27 |
| 1932113024 | Michael Harris Levine | Psychologist | 235 W Western Ave, Avondale, AZ 85323-1848 | 2006-07-27 |
| Find all providers in AVONDALE | ||||
Please comment or provide details below to improve the information on JIM F GORMAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.