Provider Demographics
NPI:1508016247
Name:GUNN PLASTIC SURGERY CENTER PLLC
Entity Type:Organization
Organization Name:GUNN PLASTIC SURGERY CENTER PLLC
Other - Org Name:LAURA GUNN MD, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-471-3406
Mailing Address - Street 1:300 CRUTCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2725
Mailing Address - Country:US
Mailing Address - Phone:919-471-3406
Mailing Address - Fax:919-471-0937
Practice Address - Street 1:300 CRUTCHFIELD ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2725
Practice Address - Country:US
Practice Address - Phone:919-471-3406
Practice Address - Fax:919-471-0937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126008208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC126TTOtherBCBS
NC2345631Medicare PIN