MEDICARE: DR. BRETT LEE GOURLEY 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207R00000X	Internal Medicine Physician	15409	NH
3	207R00000X	Internal Medicine Physician	MD604427579	WA
4	207RH0003X	Hematology & Oncology Physician	MD604427579	WA

General Provider Information

NPI Number	:	1710142070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT LEE GOURLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 3649
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-3649
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 W 5TH AVE STE 700
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99204-2967
Country	:	US
Telephone Number	:	509-838-2531
Fax Number	:	509-755-6580

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

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	06/02/2014

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