Individual
LE ROY GURGANIOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
108 MEDICAL CENTER BLVD, SUITE 100, FAYETTEVILLE, TN 37334-2741
(931) 433-1102
(931) 433-0522
Mailing address
108 MEDICAL CENTER BLVD, SUITE 100, FAYETTEVILLE, TN 37334-2741
(931) 433-1102
(931) 433-0522
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
43870
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1508795
—
TN
01
—
2864255
AETNA HMO
FL
01
—
5261266
AETNA PPO
FL
01
—
8913135002
CIGNA
FL
01
—
P00084628
RAILROAD MEDICARE
FL
Enumeration date
08/30/2006
Last updated
06/02/2011
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