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General NPI Number Information
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NPI Number | 1275770349
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Entity Type | Organization
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Legal Business Name | K G GAUNTT DPM PC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 410 VILLA ROAD
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City | NEWBERG
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State | OR
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Zip | 97132
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Country | US
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Telephone | 503-538-0466
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Fax | 503-538-0913
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Provider Business Mailing Address
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Address Line | 410 VILLA ROAD
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City | NEWBERG
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State | OR
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Zip | 97132
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Country | US
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Telephone | 503-538-0466
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Fax | 503-538-0913
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIM GARY GAUNTT
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Credential | DPM
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Telephone | 503-538-0466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | DP00197
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License Number State | OR
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