Provider Demographics
NPI:1518915057
Name:GUNN, VICTORIA (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GUNN
Suffix:
Gender:F
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:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:1620 SOUTHRIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-4005
Practice Address - Country:US
Practice Address - Phone:573-761-1830
Practice Address - Fax:573-761-1829
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9059207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201472156Medicaid
MO22590OtherBLUE SHIELD/BLUE CHOICE
MO304000OtherUNITED HEALTHCARE
MO195573OtherHEALTHLINK
KS2086969701OtherKANSAS MEDICAID
MO037011443Medicare PIN
MO070012992Medicare PIN
MO304000OtherUNITED HEALTHCARE
MO22590OtherBLUE SHIELD/BLUE CHOICE
MO195573OtherHEALTHLINK
MOP00419281Medicare PIN