1457535262 NPI number — AMELIA A. GUNTER, M.D.P.A.

Table of content: (NPI 1457535262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457535262 NPI number — AMELIA A. GUNTER, M.D.P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMELIA A. GUNTER, M.D.P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1457535262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1838
Provider Second Line Business Mailing Address:
914 FOSTER LANE
Provider Business Mailing Address City Name:
WEATHERFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76086-7838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-598-1202
Provider Business Mailing Address Fax Number:
817-598-1210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 SANTA FE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-5864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-598-1202
Provider Business Practice Location Address Fax Number:
817-598-1210
Provider Enumeration Date:
12/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUNTER
Authorized Official First Name:
AMELIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
817-598-1202

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  K9793 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 163893401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com