Provider Demographics
NPI:1710925730
Name:GUREVITCH, EARL J (MD)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:J
Last Name:GUREVITCH
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 1:1766 MAJESTIC LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6759
Mailing Address - Country:US
Mailing Address - Phone:406-373-3596
Mailing Address - Fax:406-373-3852
Practice Address - Street 1:1766 MAJESTIC LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6759
Practice Address - Country:US
Practice Address - Phone:406-373-3596
Practice Address - Fax:406-373-3852
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 79547208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10G245OtherHEALTHY KIDS
FL1193078OtherWELLCARE
FL258913300Medicaid
FL293004OtherAVMED
FLP304236OtherFREEDOM HEALTH
FL35574OtherBCBS OF FL
FL7771156OtherAETNA
FL8571010OtherCIGNA
FLP01193233OtherRAILROAD MCR
FLE3987ZMedicare PIN
FL258913300Medicaid
FL1193078OtherWELLCARE
FLP01193233OtherRAILROAD MCR