MEDICARE: DR. JOHN RICHARD GUNDERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0017044	FL

General Provider Information

NPI Number	:	1861513640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RICHARD GUNDERMAN M.D.

Provider Business Mailing Address
First Line	:	5106 N ARMENIA AVE
Second Line	:	SUITE 5
City	:	TAMPA
State	:	FL
Zip	:	33603-1433
Country	:	US
Telephone Number	:	813-879-7816
Fax Number	:	813-875-0837

Provider Business Practice Location Address
First Line	:	5106 N ARMENIA AVE
Second Line	:	SUITE 5
City	:	TAMPA
State	:	FL
Zip	:	33603-1433
Country	:	US
Telephone Number	:	813-879-7816
Fax Number	:	813-875-0837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/13/2010

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