Individual
JIM F GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MC
Contact information
Practice address
530 EAST RILEY DRIVE, AVONDALE, AZ 85323
(623) 832-7407
(623) 932-1884
Mailing address
530 EAST RILEY DRIVE, AVONDALE, AZ 85323
(623) 832-7407
(623) 932-1884
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
588668
PROVIDER ID NUMBER
AZ
01
—
594722
AHCCCS MEMBERS
AZ
Enumeration date
01/18/2007
Last updated
07/26/2007
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