Healthcare Provider Details

I. General information

NPI: 1831212844
Provider Name (Legal Business Name): GUNDA LEE KIRK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 EUREKA ST STE B
WEATHERFORD TX
76086-6521
US

IV. Provider business mailing address

2340 E TRINITY MILLS RD STE 250
CARROLLTON TX
75006-1946
US

V. Phone/Fax

Practice location:
  • Phone: 855-893-5637
  • Fax: 817-666-3873
Mailing address:
  • Phone: 855-893-5637
  • Fax: 817-666-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0523
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: