Provider Demographics
NPI:1902993512
Name:GURLEY, JEROLD P (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROLD
Middle Name:P
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:PO BOX 40118
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-0118
Mailing Address - Country:US
Mailing Address - Phone:440-816-2225
Mailing Address - Fax:
Practice Address - Street 1:7215 OLD OAK BLVD
Practice Address - Street 2:SUITE A421
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3340
Practice Address - Country:US
Practice Address - Phone:440-816-2225
Practice Address - Fax:440-816-2229
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067359207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000141898OtherANTHEM
OH0891872Medicare PIN
OH000000141898OtherANTHEM