Healthcare Provider Details

I. General information

NPI: 1053476465
Provider Name (Legal Business Name): JEFFREY ROSS GUNTER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44215 15TH ST W SUITE 309
LANCASTER CA
93534-4014
US

IV. Provider business mailing address

DEPT 6231 CUB DR. GUNTER
LOS ANGELES CA
90084-6231
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-8638
  • Fax: 909-335-8644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG63889
License Number StateCA

VIII. Authorized Official

Name: JEFFREY ROSS GUNTER
Title or Position: OWNER
Credential: MD
Phone: 909-335-8638