Provider Demographics
NPI:1649201948
Name:GUNTER MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:GUNTER MEDICAL CLINIC PLLC
Other - Org Name:GUNTER MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-870-4609
Mailing Address - Street 1:610 N 8TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-3586
Mailing Address - Country:US
Mailing Address - Phone:903-433-2416
Mailing Address - Fax:903-433-2450
Practice Address - Street 1:610 N 8TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058-3586
Practice Address - Country:US
Practice Address - Phone:903-870-4609
Practice Address - Fax:903-891-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01535207Q00000X, 363AM0700X
TXJ3759207Q00000X
TX652896363L00000X, 363LF0000X, 364SA2200X, 364SF0001X, 364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
No364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183856701Medicaid
TX183856701Medicaid