Gourde, Theresa

Gourde, Theresa is an individual health care provider with primary practice located at 10623 S Redwood Rd Suite 101, South Jordan UT 84095-2481. She recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as her primary health care specialty. Gourde, Theresa can be contacted via phone (801) 302-0899.

Contact Information

Primary practice address
10623 S Redwood Rd Suite 101 South Jordan UT 84095-2481
Phone: (801) 302-0899
Fax: (801) 302-0892
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 111485-1205 Utah

Profile Details

NPI number 1487688685
LBN Legal business name Gourde, Theresa
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Apr 3rd, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1487688685 NPPES
Utah Other 111485-1205 MEDICAL LICENSE
Utah MEDICAID 1447360383 MEDICAL LICENSE
Utah MEDICAID 1982871828 MEDICAL LICENSE

Popular Providers