Individual ProviderTy L GoreFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address214 SW 26th Ave, Suite B, Mineral Wells, TX 76067-8249(940) 325-9453PECOS EnrollmentThis provider is enrolled in PECOS as TY GORE.Based on the most recent information from CMS, provider Ty L Gore is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1578544698Provider TypeIndividualFull NameGore, Ty LTitleDr.CredentialM.D.GenderMaleSole ProprietorYesEnumeration Date11/7/2005Last Updated2/17/2012Contact InformationPractice LocationPractice Address214 SW 26th Ave, Suite B, Mineral Wells, TX 76067-8249Phone(940) 325-9453Fax(940) 325-8401Mailing LocationMailing Address214 SW 26th Ave, Suite B, Mineral Wells, TX 76067-8249Phone(940) 325-9453Fax(940) 325-8401Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseF1596Texas