Provider Demographics
NPI:1447470984
Name:ROSEANN F. GOREY M.D. INC.
Entity type:Organization
Organization Name:ROSEANN F. GOREY M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GOREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-945-0707
Mailing Address - Street 1:120 LA CASA VIA
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3067
Mailing Address - Country:US
Mailing Address - Phone:925-945-0707
Mailing Address - Fax:925-945-0910
Practice Address - Street 1:120 LA CASA VIA
Practice Address - Street 2:SUITE 207
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3067
Practice Address - Country:US
Practice Address - Phone:925-945-0707
Practice Address - Fax:925-945-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37450208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47095Medicare UPIN
CA00G374500Medicare ID - Type Unspecified