Provider Demographics
NPI:1811193550
Name:GUNTHER, JULIE K (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:K
Last Name:GUNTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 WEST IDAHO STREET
Mailing Address - Street 2:SPARKMD
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6241
Mailing Address - Country:US
Mailing Address - Phone:208-369-4590
Mailing Address - Fax:
Practice Address - Street 1:302 WEST IDAHO STREET
Practice Address - Street 2:SPARKMD
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6241
Practice Address - Country:US
Practice Address - Phone:208-369-4590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM10803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID20000310Medicare PIN