Individual
DR. GLENN RICHARD GOURLEY
Active
Individual
DR. GLENN RICHARD GOURLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
48367
MN
2080P0206X
Pediatric Gastroenterology Physician
48367
MN
2080P0206X
Pediatric Gastroenterology Physician
Primary
E-10741
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1046326
PREFERRED ONE
MN
05
—
1511089
—
IA
01
—
182562
UCARE
MN
05
—
220820200
—
MN
01
—
29-00053
MEDICA PRIMARY
MN
01
—
29-00477
MEDICA CHOICE
MN
01
—
730T5GO
BCBS
MN
Enumeration date
07/06/2006
Last updated
06/05/2019
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.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up