Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | M5738 | TX |
N | 208600000X | Surgeon | M5738 | TX |
Y | 2086S0102X | Surgical Critical Care | 49959 | AZ |
N | 2086S0102X | Surgical Critical Care | A93582 | CA |
N | 2086S0102X | Surgical Critical Care | M5738 | TX |
NPI | 1144209842 |
---|---|
Provider Name | Mark Gunst |
First Address | Los Angeles, CA 90074-6765 |
Second Address | Chandler, AZ 85224-5602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 17/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188326603 | (05) | TX |
188326604 | CSHCN ( MEDICAID) (01) | TX |
RES000 | (02) | CA |