Provider Demographics
NPI:1588657175
Name:GURLEY, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GURLEY
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 1:195 SCHOOL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MANCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01944-1700
Mailing Address - Country:US
Mailing Address - Phone:978-526-4800
Mailing Address - Fax:978-526-7179
Practice Address - Street 1:195 SCHOOL ST
Practice Address - Street 2:SUITE B
Practice Address - City:MANCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01944-1700
Practice Address - Country:US
Practice Address - Phone:978-526-4800
Practice Address - Fax:978-526-7179
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53158207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1149320001OtherMEDICARE DMERC
MA3002306Medicaid
1149320001OtherMEDICARE DMERC
MAA57193Medicare UPIN