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General NPI Number Information
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NPI Number | 1164509865
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Entity Type | Individual
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Provider Name | TONY I GAUNTT PA
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 908 ROCKMOOR DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-8966
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Country | US
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Telephone | 512-868-0901
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Fax | 512-868-1527
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Provider Business Mailing Address
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Address Line | PO BOX 2509
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City | GEORGETOWN
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State | TX
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Zip | 78627-2509
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Country | US
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Telephone | 512-868-0901
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Fax | 512-868-1527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00247
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License Number State | TX
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