Individual
EDWARD KIRKHAM GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1002 E MADISON ST, HOUSTON, MS 38851-2417
(662) 456-2037
(662) 456-1006
Mailing address
PO BOX 432, HOUSTON, MS 38851-0432
(662) 456-2037
(662) 456-1006
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04981
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00112415
—
MS
05
—
07978511
—
MS
01
—
1194833400
GROUP NPI
MS
Enumeration date
02/27/2006
Last updated
06/20/2018
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