Individual
DR. JESSE GORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
50251392501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107029545101
U006
UT
01
—
8573690
U002
UT
01
—
942938348015
U009
UT
01
—
Q11013
ICAR
UT
Enumeration date
12/13/2005
Last updated
10/18/2007
Update your record
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