Provider Demographics
NPI:1922048974
Name:GUNN, JOHN LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LAWRENCE
Last Name:GUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5295 S DURANGO DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0188
Mailing Address - Country:US
Mailing Address - Phone:702-358-0472
Mailing Address - Fax:702-425-9955
Practice Address - Street 1:2749 SUNRIDGE HEIGHTS PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5044
Practice Address - Country:US
Practice Address - Phone:702-358-0472
Practice Address - Fax:702-425-9955
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV4768207W00000X, 207WX0107X
TN11927207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D07412Medicare UPIN