Provider Demographics
NPI:1730188087
Name:GORBACK, MICHAEL SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:GORBACK
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 1:17099 TEXAS AVE
Mailing Address - Street 2:300
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4069
Mailing Address - Country:US
Mailing Address - Phone:281-554-3400
Mailing Address - Fax:281-554-3404
Practice Address - Street 1:17099 TEXAS AVE
Practice Address - Street 2:300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4069
Practice Address - Country:US
Practice Address - Phone:281-554-3400
Practice Address - Fax:281-554-3404
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7502208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine