Individual
DR. DOUGLAS EDWARD GORMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1920 CHADWICK DR, SUITE 108, JACKSON, MS 39204-3471
(601) 373-3730
(601) 372-7431
Mailing address
1920 CHADWICK DR, SUITE 108, JACKSON, MS 39204-3471
(601) 373-3730
(601) 372-7431
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
08261
MS
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
08261
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00010048
—
MS
01
—
640650720
CORP TAX ID
MS
Enumeration date
10/18/2006
Last updated
07/06/2010
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