Healthcare Provider Details

I. General information

NPI: 1134223126
Provider Name (Legal Business Name): GORDON C GUNN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LAGUNA RD
FULLERTON CA
92835-3614
US

IV. Provider business mailing address

150 LAGUNA ROAD
FULLERTON CA
92835
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-4800
  • Fax: 714-447-1098
Mailing address:
  • Phone: 714-447-4800
  • Fax: 714-447-1098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GORDON COLIN GUNN
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 714-447-4800