Basic Information
| Provider Information | |||||||||
| NPI: | 1922083401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUNTHER | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 10700 E GEDDES AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2005 | ||||||||
| LastUpdateDate: | 04/10/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 37502 | CO | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 24987 | NE | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 04-36271 | KS | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 17549 | HI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 54296 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 84-059792913 | 05 | NE | MEDICAID | P00428312 | 01 | CO | RR MEDICARE | OTHER | Q37502 | 05 | SC | MEDICAID | 100398110B | 05 | KS | MEDICAID | 1922083401/7726610 | 05 | SD | MEDICAID | 200239840A | 05 | OK | MEDICAID | 82522300 | 05 | WI | MEDICAID | 10025709000 | 05 | NE | MEDICAID | 1922083401 | 05 | UT | MEDICAID | 1922083401 | 05 | MO | MEDICAID | 1922083401 | 05 | WA | MEDICAID | 1922083401/2548247 | 05 | OH | MEDICAID | P00720357 | 01 | NE | RR MCR NE | OTHER | 80778852 | 05 | CO | MEDICAID | P00451369 | 01 | CO | RR MCR MIC | OTHER | 1679513196 | 05 | UT | MEDICAID | 1922083401 | 05 | IA | MEDICAID | 7617662 | 05 | NC | MEDICAID | 808264 | 05 | AZ | MEDICAID | 1922083401 | 05 | WY | MEDICAID | 1922083401 | 05 | CA | MEDICAID | K9328 | 05 | NM | MEDICAID | 0324193 | 05 | WA | MEDICAID |