Basic Information
| Provider Information | |||||||||
| NPI: | 1336463447 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOURLEY | ||||||||
| FirstName: | ERIC | ||||||||
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| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 CROSSROADS DR STE 306 | ||||||||
| Address2: | |||||||||
| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211175437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437382889 | ||||||||
| FaxNumber: | 4434718540 | ||||||||
| Practice Location | |||||||||
| Address1: | 11960 LIONESS WAY STE 210 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801345644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036956106 | ||||||||
| FaxNumber: | 3036951211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208800000X | DR.0064296 | CO | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | DR.0064296 | 01 | CO | STATE LICENSE | OTHER |