Organization
GEORGE C GOURLEY, DO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNA CUSHING CPC (CODING, BILLING)
(801) 357-7190
Entity
Organization
Contact information
Practice address
1055 N 300 W, SUITE 305, PROVO, UT 84604-3344
(801) 357-7190
(801) 356-3107
Mailing address
1055 N 300 W, SUITE 305, PROVO, UT 84604-3344
(801) 357-7190
(801) 356-3107
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
180191-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528785217006
—
UT
Enumeration date
08/19/2010
Last updated
08/19/2010
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