Provider Demographics
NPI:1487909289
Name:BRYAN A. GUNNOE, MD, INC.
Entity type:Organization
Organization Name:BRYAN A. GUNNOE, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPAEDIC SURGEON / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUNNOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-956-5200
Mailing Address - Street 1:12277 APPLE VALLEY RD # 396
Mailing Address - Street 2:#396
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-1701
Mailing Address - Country:US
Mailing Address - Phone:760-956-5200
Mailing Address - Fax:760-669-0793
Practice Address - Street 1:12021 JACARANDA AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4978
Practice Address - Country:US
Practice Address - Phone:760-956-5200
Practice Address - Fax:760-669-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71016174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty