Provider Demographics
NPI:1689716771
Name:JACK P. GUNTER, M.D., P.A.
Entity Type:Organization
Organization Name:JACK P. GUNTER, M.D., P.A.
Other - Org Name:GUNTER CENTER FOR AESTHETICS & COSMETIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-369-8123
Mailing Address - Street 1:8144 WALNUT HILL LN
Mailing Address - Street 2:SUITE 170
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4388
Mailing Address - Country:US
Mailing Address - Phone:214-369-8123
Mailing Address - Fax:214-369-2984
Practice Address - Street 1:8144 WALNUT HILL LN
Practice Address - Street 2:SUITE 170
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4388
Practice Address - Country:US
Practice Address - Phone:214-369-8123
Practice Address - Fax:214-369-2984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5285207Y00000X
TXD6273208200000X
TXM1906208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16389Medicare UPIN
TXJ823Medicare ID - Type Unspecified