DR. GLENN RICHARD GOURLEY M.D. NPI 1689606287

NPI Information

NPI: 1689606287
Provider Name: DR. GLENN RICHARD GOURLEY, M.D.
Classification: Pediatrics - 2080P0206X
Entity Type: Individual

Specialization: Pediatric Gastroenterology

PECOS Registration: Yes

Address:
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN
ZIP 55413
Phone: (612) 871-1145
Get Directions

DR. Glenn Richard Gourley, M.D. is a pediatric gastroenterology pediatrics in Minneapolis, MN. The provider is a pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs. DR. Glenn Richard Gourley, M.D. NPI is 1689606287. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN
ZIP 55413-197
Phone: (612) 871-1145
Fax: (612) 870-5491

The NPI 1689606287 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/6/2006 and was last updated on 6/5/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		48367	MINNESOTA	No
2	2080P0206X	Pediatrics	Pediatric Gastroenterology	48367	MINNESOTA	No
3	2080P0206X	Pediatrics	Pediatric Gastroenterology	E-10741	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	29-00477	OTHER	MINNESOTA	MEDICA CHOICE
2	1046326	OTHER	MINNESOTA	PREFERRED ONE
3	182562	OTHER	MINNESOTA	UCARE
4	29-00053	OTHER	MINNESOTA	MEDICA PRIMARY
5	730T5GO	OTHER	MINNESOTA	BCBS
6	1511089	MEDICAID	IOWA
7	220820200	MEDICAID	MINNESOTA
8	29-00053	OTHER	MINNESOTA	MEDICA CHOICE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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