Provider Demographics
NPI:1144209842
Name:GUNST, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GUNST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE 56765
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-6765
Mailing Address - Country:US
Mailing Address - Phone:602-406-3860
Mailing Address - Fax:602-406-6132
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-728-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5738208600000X, 2086S0102X
CAA935822086S0102X
AZ499592086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188326604OtherCSHCN ( MEDICAID)
TX188326603Medicaid
TXTXB110239 (00T156)Medicare PIN
TX188326604OtherCSHCN ( MEDICAID)