Provider Demographics
NPI:1477555712
Name:GOURLEY, DAVID SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:GOURLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1660 W ANTELOPE DR
Mailing Address - Street 2:STE 225
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1156
Mailing Address - Country:US
Mailing Address - Phone:801-775-9800
Mailing Address - Fax:801-775-9806
Practice Address - Street 1:6065 S FASHION BLVD
Practice Address - Street 2:STE 255
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7381
Practice Address - Country:US
Practice Address - Phone:801-266-4115
Practice Address - Fax:801-266-4138
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT90-183859-1205207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
030001480OtherRAILROAD MEDICARE
UT1838591205OtherUT PROFESSIONAL LICENSE
000010032Medicare ID - Type Unspecified
030001480OtherRAILROAD MEDICARE
UT1838591205OtherUT PROFESSIONAL LICENSE