Provider Demographics
NPI:1346251246
Name:GAUNT, TINA G (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:G
Last Name:GAUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26901 US HIGHWAY 119 N
Mailing Address - Street 2:
Mailing Address - City:BELFRY
Mailing Address - State:KY
Mailing Address - Zip Code:41514-7520
Mailing Address - Country:US
Mailing Address - Phone:606-237-0327
Mailing Address - Fax:606-237-6624
Practice Address - Street 1:26901 US HIGHWAY 119 N
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-7520
Practice Address - Country:US
Practice Address - Phone:606-237-0327
Practice Address - Fax:606-237-6624
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY36641207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64047434Medicaid
KY64047434Medicaid
KY0997901Medicare ID - Type Unspecified