Healthcare Provider Details

I. General information

NPI: 1710196290
Provider Name (Legal Business Name): RICHARD K GURGEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 N MEDICAL DR SOM 3C120
SALT LAKE CITY UT
84132-0001
US

IV. Provider business mailing address

50 N MEDICAL DR SCHOOL OF MEDICINE #3C120
SALT LAKE CITY UT
84132-0001
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-7514
  • Fax: 801-585-5744
Mailing address:
  • Phone: 801-581-5615
  • Fax: 801-587-3982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number8233789-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: