Individual
MICHAEL JUSTIN GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
10521 JEFFREYS ST STE 100, HENDERSON, NV 89052-4181
(702) 269-6345
(702) 269-9422
Mailing address
6355 S BUFFALO DR FL 3, LAS VEGAS, NV 89113-2133
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
38165
CO
207Q00000X
Family Medicine Physician
Primary
DO1423
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356342364
—
NV
01
—
DO1423
STATE LICENSE
NV
Enumeration date
08/02/2005
Last updated
04/06/2023
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