MEDICARE: STEVEN R GUNDRY MD MEDICAL CORPORATION

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

General Provider Information

NPI Number	:	1760849905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN R GUNDRY MD MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	555 E TACHEVAH DR STE 3W103
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5747
Country	:	US
Telephone Number	:	760-323-5553
Fax Number	:	760-323-5554

Provider Business Practice Location Address
First Line	:	555 E TACHEVAH DR STE 3W103
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-5747
Country	:	US
Telephone Number	:	760-323-5553
Fax Number	:	760-323-5554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN ROBERT GUNDRY
Credential	:	MD
Telephone Number	:	760-323-5553

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	02/01/2016

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