Individual
DOUGLAS STEVEN GORACKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
509 W 18TH ST, HERMANN, MO 65041-1547
(573) 486-2191
(573) 486-0910
Mailing address
PO BOX 19, HERMANN, MO 65041-0019
(573) 486-1193
(573) 486-0910
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
04-22640
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050018992
RAILROAD MEDICARE
—
05
—
100133270A
—
KS
01
—
1114921889
NATIONAL PROVIDER IDENTIFICATION
—
05
—
202985016
—
MO
Enumeration date
06/09/2005
Last updated
10/08/2018
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