Individual
JAY R GORHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1201 S MILLER ST STE A, WENATCHEE, WA 98801-3201
(509) 663-8711
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD00018552
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801827753
—
WA
01
—
315806
WVH LNI
WA
01
—
P01211966
RR MEDICARE WVH
WA
Enumeration date
07/06/2006
Last updated
07/14/2015
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