1306980164 NPI number — DR. CHANDLER TAMARA GUNNING DO

Table of content: DR. CHANDLER TAMARA GUNNING DO (NPI 1306980164)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306980164 NPI number — DR. CHANDLER TAMARA GUNNING DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNNING
Provider First Name:
CHANDLER
Provider Middle Name:
TAMARA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUNNING
Provider Other First Name:
CHANDLER
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO PC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306980164
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5048 E FRIESS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-996-7278
Provider Business Mailing Address Fax Number:
480-668-0766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3740 E SOUTHERN
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-668-0711
Provider Business Practice Location Address Fax Number:
480-668-0766
Provider Enumeration Date:
02/16/2007

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: 2084P0800X , with the licence number:  3071 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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