MEDICARE: WILLIAM DOUGLAS GURLEY 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	207XX0801X	Orthopaedic Trauma Physician	84190	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00NM009T49	OTHER	NM	BCBS
2	P00255231	OTHER		RAILROAD MCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	10016521	OTHER	NM	CIGNA/LOVELACE

General Provider Information

NPI Number	:	1407830466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM DOUGLAS GURLEY MD

Provider Business Mailing Address
First Line	:	2300 E 30TH ST BLDG D
Second Line	:	STE 101
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-327-1400
Fax Number	:	505-327-3474

Provider Business Practice Location Address
First Line	:	2300 E 30TH ST BLDG D
Second Line	:	STE 101
City	:	FARMINGTON
State	:	NM
Zip	:	87401-8990
Country	:	US
Telephone Number	:	505-327-1400
Fax Number	:	505-327-3474

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	05/06/2008

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Directions to “ WILLIAM DOUGLAS GURLEY MD” Practice Location

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