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General NPI Number Information
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NPI Number | 1477555712
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Entity Type | Individual
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Provider Name | DAVID SCOTT GOURLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 6065 S FASHION BLVD STE 255
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City | MURRAY
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State | UT
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Zip | 84107-7381
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Country | US
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Telephone | 801-266-4115
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Fax | 801-266-4138
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Provider Business Mailing Address
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Address Line | 1660 W ANTELOPE DR STE 225
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City | LAYTON
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State | UT
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Zip | 84041-1156
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Country | US
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Telephone | 801-775-9800
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Fax | 801-775-9806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 90-183859-1205
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License Number State | UT
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