Organization
K G GAUNTT DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM GARY GAUNTT DPM (PRESIDENT)
(503) 538-0466
Entity
Organization
Contact information
Practice address
410 VILLA ROAD, NEWBERG, OR 97132
(503) 538-0466
(503) 538-0913
Mailing address
410 VILLA ROAD, NEWBERG, OR 97132
(503) 538-0466
(503) 538-0913
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DP00197
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001656
—
OR
Enumeration date
01/12/2009
Last updated
01/12/2009
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