Organization
CLEAR WATER MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM ANTHONY GORE PA (MANAGING MEMBER)
(910) 465-2783
Entity
Organization
Contact information
Practice address
4912 LAKE RENAISSANCE CIR, WILMINGTON, NC 28409-3303
(910) 465-2783
(910) 794-4531
Mailing address
PO BOX 16310, WILMINGTON, NC 28408-6310
(910) 465-2783
(910) 794-4531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
101955
NC
Other
Enumeration date
12/01/2010
Last updated
12/01/2010
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