Individual
JEFFREY RYAN GOURLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
110 KINGLEY LANE, SUITE 305, NORFOLK, VA 23505-4617
(757) 889-5942
(757) 889-5450
Mailing address
110 KINGSLEY LN STE 305, NORFOLK, VA 23505-4617
(757) 889-5422
(757) 889-5450
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101245462
VA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
0101245462
VA
Other
Enumeration date
04/21/2009
Last updated
06/18/2019
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