Provider Demographics
NPI:1235146333
Name:GORANG, ALAN D (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:GORANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-501-5610
Mailing Address - Fax:
Practice Address - Street 1:9720 S 1300 E
Practice Address - Street 2:#230E
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3712
Practice Address - Country:US
Practice Address - Phone:801-501-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1779481205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT00011126Medicare PIN