Organization
DANIEL E GORMLEY MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL E GORMLEY MD (OWNER PRESIDENT)
(626) 963-7684
Entity
Organization
Contact information
Practice address
412 W CARROLL AVE, SUITE #207, GLENDORA, CA 91741-4280
(626) 963-7684
(626) 963-0575
Mailing address
412 W CARROLL AVE, SUITE #207, GLENDORA, CA 91741-4280
(626) 963-7684
(626) 963-0575
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A21148
CA
207ND0101X
MOHS-Micrographic Surgery Physician
A21148
CA
207ND0900X
Dermatopathology Physician
A21148
CA
207NS0135X
Procedural Dermatology Physician
A21148
CA
Other
Enumeration date
09/06/2006
Last updated
02/19/2008
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