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General NPI Number Information
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NPI Number | 1871739482
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Entity Type | Organization
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Legal Business Name | K. G. GAUNTT D.P.M.
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Dates
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Enumeration Date | 01/02/2009
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Last Update Date | 01/02/2009
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Provider Practice Location Address
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Address Line | 410 VILLA RD
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City | NEWBERG
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State | OR
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Zip | 97132-1853
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Country | US
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Telephone | 503-538-0466
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Fax |
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Provider Business Mailing Address
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Address Line | 200 NE 4TH AVENUE
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City | HILLSBORO
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State | OR
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Zip | 97124-3127
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Country | US
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Telephone | 503-538-0466
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Fax |
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Authorized Official
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Title or Position | ACCOUNTS MANAGER
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Name | MRS. GAIL SHEPHERD
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Credential |
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | DP00197
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License Number State | OR
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