Individual
KENNETH MARK GORMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 UNION AVE, MEMPHIS, TN 38104-3415
(901) 516-8279
Mailing address
2263 YOUNG AVE APT 217, MEMPHIS, TN 38104-5768
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
349797
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2023
Last updated
11/09/2025
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