Individual
MR. GAVIN BLAIR GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
19500 SANDRIDGE WAY, SUITE 420, LEESBURG, VA 20176-3467
(571) 375-8601
(571) 223-6773
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101258174
VA
2085R0202X
Diagnostic Radiology Physician
2013-02510
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316189608
—
VA
Enumeration date
04/01/2009
Last updated
11/29/2022
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