Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | C27175 | CA |
NPI | 1194829184 |
---|---|
Provider Name | Dr. Gordon Colin Gunn |
First Address | Fullerton, CA 92835-3813 |
Second Address | Fullerton, CA 92835-3813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 21/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C271750 | (05) | CA |
A33296 | (02) | |
WC27175C | MEDICARE PTAN (01) | CA |