1194829184 NPI number — DR. GORDON COLIN GUNN MD

Table of content: DR. GORDON COLIN GUNN MD (NPI 1194829184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194829184 NPI number — DR. GORDON COLIN GUNN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNN
Provider First Name:
GORDON
Provider Middle Name:
COLIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194829184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 E VALENCIA MESA DR
Provider Second Line Business Mailing Address:
SUITE # 215
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-3813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-912-2211
Provider Business Mailing Address Fax Number:
714-213-8750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 E VALENCIA MESA DR
Provider Second Line Business Practice Location Address:
SUITE # 215
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-3813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-912-2211
Provider Business Practice Location Address Fax Number:
714-213-8750
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  C27175 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00C271750 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: WC27175C . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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