Individual
DEITRICK L GORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2349 MEDICAL DR, PECOS, TX 79772-2251
(432) 447-0565
(432) 447-5053
Mailing address
2349 MEDICAL DR, PECOS, TX 79772-2251
(432) 447-0565
(432) 447-5053
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N4435
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211545301
—
TX
Enumeration date
08/10/2006
Last updated
09/10/2025
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