Provider Demographics
NPI:1457535262
Name:AMELIA A. GUNTER, M.D.P.A.
Entity type:Organization
Organization Name:AMELIA A. GUNTER, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-598-1202
Mailing Address - Street 1:PO BOX 1838
Mailing Address - Street 2:914 FOSTER LANE
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7838
Mailing Address - Country:US
Mailing Address - Phone:817-598-1202
Mailing Address - Fax:817-598-1210
Practice Address - Street 1:920 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5864
Practice Address - Country:US
Practice Address - Phone:817-598-1202
Practice Address - Fax:817-598-1210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9793208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163893401Medicaid
TX00537VMedicare PIN
TXTXB115167Medicare PIN
TX163893401Medicaid