Individual
JILL M GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 539-9582
Mailing address
6915 WEST AVE, SAN ANTONIO, TX 78213-1822
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA04773
TX
363AM0700X
Medical Physician Assistant
PA04773
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8Y0190
BLUECROSS BLUESHIELD TX.
TX
Enumeration date
06/25/2006
Last updated
10/03/2022
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