Healthcare Provider Details

I. General information

NPI: 1922426162
Provider Name (Legal Business Name): JONATHAN GUMER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

IV. Provider business mailing address

1901 TATE SPRINGS RD
LYNCHBURG VA
24501-1109
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-3000
  • Fax:
Mailing address:
  • Phone: 727-341-4819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0102207333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: