Provider Demographics
NPI:1386964666
Name:GUNDERT, EMILY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIZABETH
Last Name:GUNDERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:LAUBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:317-962-5975
Practice Address - Fax:317-963-5394
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01073019A207P00000X
TXQ5193207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201101660Medicaid
IN201101660Medicaid
INP01433077Medicare PIN
INP01350083Medicare PIN
IN264430135Medicare PIN