Provider Demographics
NPI:1902852767
Name:REID, ERIN GOURLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:GOURLEY
Last Name:REID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MC 0987
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9000
Mailing Address - Country:US
Mailing Address - Phone:858-822-6197
Mailing Address - Fax:858-822-6198
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MC 0987
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:858-822-6197
Practice Address - Fax:858-822-6198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73308207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI06895Medicare UPIN