Provider Demographics
NPI:1770657363
Name:GURLEY, JUDITH M (MD, FACS)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:M
Last Name:GURLEY
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14825 N. OUTER 40 ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:636-812-4300
Mailing Address - Fax:636-812-4307
Practice Address - Street 1:14825 N. OUTER 40 ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:636-812-4300
Practice Address - Fax:636-812-4307
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114740174400000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG88405Medicare UPIN
MO0001014469Medicare ID - Type Unspecified