Healthcare Provider Details

I. General information

NPI: 1134183874
Provider Name (Legal Business Name): PATRICIA A GUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 COIT RD
PLANO TX
75075-6163
US

IV. Provider business mailing address

16980 DALLAS PKWY SUITE 200
DALLAS TX
75248-1908
US

V. Phone/Fax

Practice location:
  • Phone: 972-985-8838
  • Fax: 972-596-1724
Mailing address:
  • Phone: 972-391-1915
  • Fax: 972-391-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberL6408
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: