Dr. Glenn Richard Gourley
M.D. | Pediatric Gastroenterology | Male
Dr. Glenn Richard Gourley, M.D. is a Minneapolis, Minnesota based Pediatric doctor with medical specialization in
Pediatric Gastroenterology.
Current practice location of Dr. Glenn Richard Gourley is
3001 Broadway St Ne Ste 500, Minneapolis, Minnesota - 55413-2197. He can be contacted on phone at
612-871-1145 and fax number 612-870-5491.
Dr. Glenn Richard Gourley is a sole proprietor of his business.
NPI number (Unique professional ID) for Dr. Glenn Richard Gourley is
1689606287 which was assigned by NPPES on 06 Jul, 2006 and it was last updated on 05 Jun, 2019.
Dr. Glenn Richard Gourley license number is
E-10741 for Pediatrics Pediatric Gastroenterology (2080P0206X) in Arkansas.
Dr. Glenn Richard Gourley specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.
Complete Profile:
Dr. Glenn Richard Gourley basic information including his official name, gender, specialization, credentials etc. are as mentioned below.
| Specialization : | Pediatrics Pediatric Gastroenterology |
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| Provider Name : | Dr. Glenn Richard Gourley |
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| Credential : | M.D. |
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| Gender : | Male |
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Business Address:
Dr. Glenn Richard Gourley address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.
| Primary Address : | 3001 Broadway St Ne Ste 500
Minneapolis, MN, 55413-2197
United States |
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| Phone Number : | 612-871-1145 |
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| Fax Number : | 612-870-5491 |
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Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.
| NPI Number : | 1689606287 |
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| NPI Entity Type : | Individual |
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| First Enrolment Date : | 06 Jul, 2006 |
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| Last Updated On : | 05 Jun, 2019 |
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Licenses and Specialities:
Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Glenn Richard Gourley are as mentioned. Primary taxonomy code for Dr. Glenn Richard Gourley, M.D. is
2080P0206X (Pediatrics Pediatric Gastroenterology).
| Taxonomy Code | Speciality | Primary | License No. | State |
|---|
| 208000000X | Pediatrics | No | 48367 | MN |
| 2080P0206X | Pediatrics Pediatric Gastroenterology | Yes | E-10741 | AR |
| 2080P0206X | Pediatrics Pediatric Gastroenterology | No | 48367 | MN |
Legacy Identifiers:
Other legacy medical identifiers of Dr. Glenn Richard Gourley such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.
| Identifier | Identifier Type | State | Issuer |
|---|
| 29-00477 | Other | MN | MEDICA CHOICE |
| 1046326 | Other | MN | PREFERRED ONE |
| 182562 | Other | MN | UCARE |
| 29-00053 | Other | MN | MEDICA PRIMARY |
| 730T5GO | Other | MN | BCBS |
| 1511089 | MEDICAID | IA | |
| 220820200 | MEDICAID | MN | |
| 29-00053 | Other | MN | MEDICA CHOICE |
Mailing Address:
Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.
| Mailing Address : | Po Box 14909
Minneapolis, MN, 55414-0909
United States |
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| Phone Number : | 612-871-1145 |
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| Fax Number : | 612-870-5491 |
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Business Location:
Patients can refer following map for directions to
Dr. Glenn Richard Gourley practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.