Provider Demographics
NPI:1548398647
Name:MICHAEL J GUNTER LTD
Entity Type:Organization
Organization Name:MICHAEL J GUNTER LTD
Other - Org Name:CANYON TRAILS FAMILY PRACTICE & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-228-7117
Mailing Address - Street 1:7455 W WASHINGTON AVE
Mailing Address - Street 2:SUITE 445
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4337
Mailing Address - Country:US
Mailing Address - Phone:702-804-5138
Mailing Address - Fax:702-804-5364
Practice Address - Street 1:7455 W WASHINGTON AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4337
Practice Address - Country:US
Practice Address - Phone:702-804-5138
Practice Address - Fax:702-804-5364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8113207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV30731Medicare PIN