Provider Demographics
NPI:1184797920
Name:GUNNELS, PAUL JAMES (OWNER)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:GUNNELS
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:ANN
Other - Last Name:GUNNELS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:7516 LAKE MARSHA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7734
Mailing Address - Country:US
Mailing Address - Phone:407-363-4575
Mailing Address - Fax:407-363-0162
Practice Address - Street 1:7516 LAKE MARSHA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7734
Practice Address - Country:US
Practice Address - Phone:407-363-4575
Practice Address - Fax:407-363-0162
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL05000086822332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies