=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194829184
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GORDON COLIN GUNN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 03/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 E VALENCIA MESA DR SUITE # 215
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-912-2211
-----------------------------------------------------
Fax | 714-213-8750
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 E VALENCIA MESA DR SUITE # 215
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-3813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-912-2211
-----------------------------------------------------
Fax | 714-213-8750
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | C27175
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------