Provider Demographics
NPI:1902822281
Name:GUNN, NADEGE TACHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NADEGE
Middle Name:TACHA
Last Name:GUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 FISH POND RD STE 103
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2582
Mailing Address - Country:US
Mailing Address - Phone:254-294-4780
Mailing Address - Fax:254-294-4780
Practice Address - Street 1:6600 FISH POND RD STE 103
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2582
Practice Address - Country:US
Practice Address - Phone:254-294-4780
Practice Address - Fax:254-294-4781
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29135207RG0100X
VA0101258366207RG0100X
GA074062207RG0100X
TXR4710207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN