Individual
PENNY ELAINE GORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1101 S MAIN ST, FT WORTH, TX 76104-4802
(817) 321-4700
Mailing address
2400 PRESIDENTIAL DR, CLEBURNE, TX 76031-0303
(682) 472-6651
Taxonomy
Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
555439
TX
Other
Enumeration date
09/11/2013
Last updated
09/11/2013
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