1124290275 NPI number — DR. JOSEPH WILLIAM GUNTER III M.D.

Table of content: DR. JOSEPH WILLIAM GUNTER III M.D. (NPI 1124290275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124290275 NPI number — DR. JOSEPH WILLIAM GUNTER III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNTER
Provider First Name:
JOSEPH
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124290275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36702-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-920-7871
Provider Business Mailing Address Fax Number:
615-920-8960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1023 MEDICAL CENTER PKWY
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36701-6750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-418-6656
Provider Business Practice Location Address Fax Number:
334-418-6657
Provider Enumeration Date:
03/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD.34993 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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