Provider Demographics
NPI:1902491905
Name:GOREE, CHANTIL
Entity Type:Individual
Prefix:
First Name:CHANTIL
Middle Name:
Last Name:GOREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHANTIL
Other - Middle Name:
Other - Last Name:GOREE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2601 PEARL
Mailing Address - Street 2:
Mailing Address - City:SEAGOVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75159-2457
Mailing Address - Country:US
Mailing Address - Phone:214-957-7702
Mailing Address - Fax:
Practice Address - Street 1:2601 PEARL
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2457
Practice Address - Country:US
Practice Address - Phone:214-957-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16397786343800000X, 347C00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle