Individual
MR. KIM GARY GAUNTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
410 VILLA ROAD, NEWBERG, OR 97132-1904
(503) 538-0466
(503) 538-0913
Mailing address
410 VILLA ROAD, NEWBERG, OR 97132-1904
(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
09/01/2006
Last updated
01/16/2014
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