Provider Demographics
NPI:1407830466
Name:GURLEY, WILLIAM DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:GURLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E 30TH ST BLDG D
Mailing Address - Street 2:STE 101
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8990
Mailing Address - Country:US
Mailing Address - Phone:505-327-1400
Mailing Address - Fax:505-327-3474
Practice Address - Street 1:2300 E 30TH ST BLDG D
Practice Address - Street 2:STE 101
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-327-1400
Practice Address - Fax:505-327-3474
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84190207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM009T49OtherBCBS
P00255231OtherRAILROAD MCARE
NM16358759Medicaid
NM10016521OtherCIGNA/LOVELACE
D24709Medicare UPIN
NM16358759Medicaid
NM0266220001Medicare NSC