Individual
THERESA GOURDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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