Individual
DR. MARK RICHARD GORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
10214 N TATUM BLVD STE B300, PHOENIX, AZ 85028-4233
(602) 954-0777
Mailing address
8475 E HARTFORD DR STE 201, SCOTTSDALE, AZ 85255-5477
(480) 591-9345
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
0069
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0065330
BCBSAZ PROVIDER #
AZ
01
—
700444
AHCCCS
AZ
Enumeration date
06/22/2005
Last updated
08/08/2022
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