Gourley, Glenn Richard

Gourley, Glenn Richard is an individual health care provider with primary practice located at 3001 Broadway St Ne Ste 500 , Minneapolis MN 55413-2197. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Gastroenterology. Allopathic & Osteopathic Physicians / Pediatric Gastroenterology is his primary health care specialty. Gourley, Glenn Richard can be contacted via phone (612) 871-1145.

Contact Information

Primary practice address
3001 Broadway St Ne Ste 500 Minneapolis MN 55413-2197
Phone: (612) 871-1145
Fax: (612) 870-5491
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 48367 Minnesota
Allopathic & Osteopathic Physicians / Pediatric Gastroenterology 2080P0206X 48367 Minnesota
Allopathic & Osteopathic Physicians / Pediatric Gastroenterology 2080P0206X E-10741 Arkansas

Profile Details

NPI number 1689606287
LBN Legal business name Gourley, Glenn Richard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2006
Last updated Jun 5th, 2019 - about 6 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689606287 NPPES
Minnesota Other 29-00053 MEDICA PRIMARY
Minnesota Other 1046326 MEDICA PRIMARY
Minnesota MEDICAID 1511089 MEDICA PRIMARY
Minnesota Other 730T5GO MEDICA PRIMARY
Minnesota Other 182562 MEDICA PRIMARY
Minnesota Other 29-00477 MEDICA PRIMARY
Minnesota Other 29-00053 MEDICA PRIMARY
Minnesota MEDICAID 220820200 MEDICA PRIMARY

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