Provider Demographics
NPI:1588601702
Name:GUNTER, JEFFREY ROSS (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROSS
Last Name:GUNTER
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:DEPT 6231
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-0001
Mailing Address - Country:US
Mailing Address - Phone:909-335-8638
Mailing Address - Fax:909-335-8644
Practice Address - Street 1:44215 15TH ST W
Practice Address - Street 2:309
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63889207N00000X
NV7114207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV37686Medicare ID - Type Unspecified
CAG638890Medicare ID - Type Unspecified
CAG63889AMedicare ID - Type Unspecified
CAG63889BMedicare ID - Type Unspecified