Healthcare Provider Details

I. General information

NPI: 1952384943
Provider Name (Legal Business Name): GREGORY KEVIN GUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 FRANKLIN ST SE SUITE 200
HUNTSVILLE AL
35801-4551
US

IV. Provider business mailing address

2006 FRANKLIN ST SE SUITE 200
HUNTSVILLE AL
35801-4551
US

V. Phone/Fax

Practice location:
  • Phone: 256-539-0457
  • Fax: 256-539-5827
Mailing address:
  • Phone: 256-539-0457
  • Fax: 256-539-5827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13519
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.016748
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number55139
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: