Healthcare Provider Details

I. General information

NPI: 1992944656
Provider Name (Legal Business Name): LAURA M GUNDER MCCLARY P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA M GUNDER P.A.

II. Dates (important events)

Enumeration Date: 02/19/2009
Last Update Date: 02/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 BUCKINGHAM WAY
SAINT CLOUD FL
34772-8747
US

IV. Provider business mailing address

3301 BUCKINGHAM WAY
SAINT CLOUD FL
34772-8747
US

V. Phone/Fax

Practice location:
  • Phone: 916-790-0636
  • Fax:
Mailing address:
  • Phone: 916-790-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9108898
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberSC1391FP
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: