Provider Demographics
NPI:1952385684
Name:GURNEY, EDMUND REED JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:REED
Last Name:GURNEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-0000
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-266-4501
Practice Address - Street 1:324 4TH STREET
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458-1066
Practice Address - Country:US
Practice Address - Phone:541-572-2111
Practice Address - Fax:541-572-5743
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10881207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherNBMC NPI NUMBER-GROUP
OR930635514OtherGROUP TAX NUMBER
ORP00288564OtherRR MEDICARE PTAN NUMBER
ORR0000WFBTVOtherGROUP PIN NUMBER
OR234328Medicaid
ORCB3544OtherRR MEDICARE GROUP NUMBER
ORR130435Medicare PIN
ORP00288564OtherRR MEDICARE PTAN NUMBER
OR0577260001Medicare NSC