MEDICARE: LOUISE CONKLIN GUNTER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA02516	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8D9298	OTHER	TX	MEDICARE ID, UNSPECIFIED

General Provider Information

NPI Number	:	1003858226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE CONKLIN GUNTER P.A.

Provider Business Mailing Address
First Line	:	5425 W SPRING CREEK PKWY
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75024-4236
Country	:	US
Telephone Number	:	972-599-9600
Fax Number	:	972-599-9696

Provider Business Practice Location Address
First Line	:	5425 W SPRING CREEK PKWY
Second Line	:	SUITE 200
City	:	PLANO
State	:	TX
Zip	:	75024-4236
Country	:	US
Telephone Number	:	972-599-9600
Fax Number	:	972-599-9696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/03/2015

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