Provider Demographics
NPI:1669117016
Name:GAUNT, LOUISE (DO)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:GAUNT
Suffix:
Gender:F
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:BRANCH HEALTH CLINIC IWAKUNI
Mailing Address - Street 2:PSC 561 BOX 1877
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96382
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BRANCH HEALTH CLINIC IWAKUNI
Practice Address - Street 2:PSC 561 1877
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96310
Practice Address - Country:JP
Practice Address - Phone:315-253-3445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-30
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X, 171000000X
VA0102208122208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice