MEDICARE: NELSON P GURNEY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	3642511	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10100424	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1770698508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON P GURNEY MD

Provider Business Mailing Address
First Line	:	4857 MANHATTAN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2265
Country	:	US
Telephone Number	:	815-399-0599
Fax Number	:	815-399-2499

Provider Business Practice Location Address
First Line	:	4857 MANHATTAN DR
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2265
Country	:	US
Telephone Number	:	815-399-0599
Fax Number	:	815-399-2499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/17/2007

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