Organization
PENINSULA SURGICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID LEON GORE JR. M.D. (PRESIDENT)
(757) 827-2040
Entity
Organization
Contact information
Practice address
4000 COLISEUM DR, SUITE 200, HAMPTON, VA 23666-5906
(757) 827-2040
(757) 827-2055
Mailing address
4000 COLISEUM DR, SUITE 200, HAMPTON, VA 23666-5906
(757) 827-2040
(757) 827-2055
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101036761
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7301511
—
VA
Enumeration date
11/13/2006
Last updated
08/22/2020
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