Provider Demographics
NPI:1255376398
Name:GUNNELL, M.D., INC
Entity type:Organization
Organization Name:GUNNELL, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER/HEAD PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-253-7005
Mailing Address - Street 1:3230 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3673
Mailing Address - Country:US
Mailing Address - Phone:707-253-7005
Mailing Address - Fax:707-253-7271
Practice Address - Street 1:3230 BEARD RD
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3673
Practice Address - Country:US
Practice Address - Phone:707-253-7005
Practice Address - Fax:707-253-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62275207RN0300X
CAG78785207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ83972ZMedicare ID - Type Unspecified