Doctor Name: | RAYMOND LESLIE GUNDRY |
NPI Number: | 1265404628 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 22816 |
Business Practice Address: | Tfs - Force Surgeon Unit #31520 Apo, AE - 09832 |
Business Phone Number: | 011-9728-628-1801 |
Business Fax Number: | |
Mailing Address: | Tfs - Force Surgeon, Unit #31520 APO |
State: | AE |
Postal Code: | 09832 |
Phone Number: | 011-9728-628-1801 |
Fax Number: | |
NPI Enumeration Date: | 02/01/2006 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171000000X |
License Number: | 22816 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Military Health Care Provider |
Taxonomy Specialization: | |
Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |