Individual
THERESA GOURDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10623 S REDWOOD RD, SUITE 101, SOUTH JORDAN, UT 84095-2481
(801) 302-0899
(801) 302-0892
Mailing address
10623 S REDWOOD RD, SUITE 101, SOUTH JORDAN, UT 84095-2481
(801) 302-0899
(801) 302-0892
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
111485-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111485-1205
MEDICAL LICENSE
UT
05
—
1447360383
—
UT
05
—
1982871828
—
UT
Enumeration date
07/11/2006
Last updated
04/03/2010
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