Provider Demographics
NPI:1912977521
Name:GUNTER, ROGER WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:WILLIAM
Last Name:GUNTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 DOLAN DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-7684
Mailing Address - Country:US
Mailing Address - Phone:850-937-2437
Mailing Address - Fax:
Practice Address - Street 1:JACC
Practice Address - Street 2:790 VETERANS WAY
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507
Practice Address - Country:US
Practice Address - Phone:850-452-6326
Practice Address - Fax:850-452-6459
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9105399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant