Doctor Name: | REGINA Z GUM |
NPI Number: | 1427049121 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 301 |
Business Practice Address: | 101 Baldwin Dr Leland, NC - 284518249 |
Business Phone Number: | 9103831500 |
Business Fax Number: | 9103831504 |
Mailing Address: | Po Box 837, LELAND |
State: | NC |
Postal Code: | 284510837 |
Phone Number: | 9103831500 |
Fax Number: | 9103831504 |
NPI Enumeration Date: | 11/02/2005 |
NPI Last Update Date: | 04/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 301 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |