Provider Demographics
NPI:1053305250
Name:NUNN, GARY P SR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:P
Last Name:NUNN
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3824
Mailing Address - Country:US
Mailing Address - Phone:501-375-3326
Mailing Address - Fax:501-375-4245
Practice Address - Street 1:1024 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3824
Practice Address - Country:US
Practice Address - Phone:501-375-3326
Practice Address - Fax:501-375-4245
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112351001Medicaid
AR112351001Medicaid
C67882Medicare UPIN