Provider Demographics
NPI:1053476465
Name:JEFFREY ROSS GUNTER MD INC
Entity Type:Organization
Organization Name:JEFFREY ROSS GUNTER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-335-8638
Mailing Address - Street 1:DEPT 6231
Mailing Address - Street 2:CUB DR. GUNTER
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-6231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44215 15TH ST W
Practice Address - Street 2:SUITE 309
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4014
Practice Address - Country:US
Practice Address - Phone:909-335-8638
Practice Address - Fax:909-335-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63889207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37684Medicare ID - Type Unspecified
CAZZZ25175ZMedicare ID - Type Unspecified
CAZZZ25173ZMedicare ID - Type Unspecified
CAZZZ25171ZMedicare ID - Type Unspecified
CAG63889BMedicare ID - Type Unspecified
CAZZZ25174ZMedicare ID - Type Unspecified