Provider Demographics
NPI:1760656607
Name:JUDITH GURLEY PLASTIC SURGERY, LLC
Entity Type:Organization
Organization Name:JUDITH GURLEY PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MORIN
Authorized Official - Last Name:GURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-812-4300
Mailing Address - Street 1:14825 N OUTER 40
Mailing Address - Street 2:#350
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:636-812-4300
Mailing Address - Fax:636-812-4307
Practice Address - Street 1:14825 N OUTER 40
Practice Address - Street 2:#350
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:636-812-4300
Practice Address - Fax:636-812-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114740208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty