Provider Demographics
NPI:1790427649
Name:REICHENBERGER, GUNNAR MAXIMILLIAN (DO)
Entity Type:Individual
Prefix:
First Name:GUNNAR
Middle Name:MAXIMILLIAN
Last Name:REICHENBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN STREET
Mailing Address - Street 2:SUITE JJL 2ND FLOOR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-500-7882
Mailing Address - Fax:713-500-0758
Practice Address - Street 1:6431 FANNIN STREET
Practice Address - Street 2:SUITE JJL 2ND FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-500-7882
Practice Address - Fax:713-500-0758
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program