Individual
JERRY P GORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
240 SAUNDERS RD, RIVERWOODS, IL 60015-3835
(847) 236-1701
(847) 236-1705
Mailing address
240 SAUNDERS RD, RIVERWOODS, IL 60015-3835
(847) 236-1701
(847) 236-1705
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
—
IL
208D00000X
General Practice Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004932196
BC/BS
IL
Enumeration date
09/29/2006
Last updated
12/28/2007
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