Healthcare Provider Details

I. General information

NPI: 1477555712
Provider Name (Legal Business Name): DAVID SCOTT GOURLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 S FASHION BLVD STE 255
MURRAY UT
84107-7381
US

IV. Provider business mailing address

1660 W ANTELOPE DR STE 225
LAYTON UT
84041-1156
US

V. Phone/Fax

Practice location:
  • Phone: 801-266-4115
  • Fax: 801-266-4138
Mailing address:
  • Phone: 801-775-9800
  • Fax: 801-775-9806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number90-183859-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: