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Individual

ANTHONY GUNAWAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
500 E THORPE ST, LAKIN, KS 67860-9625
(620) 355-7111
Mailing address
500 E THORPE ST, LAKIN, KS 67860-9625

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02416
KS
363A00000X
Physician Assistant
PA12978
TX

Other

Enumeration date
08/18/2019
Last updated
12/08/2020
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