Provider Demographics
NPI:1801880299
Name:GORMAN, BRENT E (DO)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:E
Last Name:GORMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 TEASLEY LN
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-7282
Mailing Address - Country:US
Mailing Address - Phone:940-566-5010
Mailing Address - Fax:940-382-0980
Practice Address - Street 1:1512 TEASLEY LN
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-7282
Practice Address - Country:US
Practice Address - Phone:940-566-5010
Practice Address - Fax:940-382-0980
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF9488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine