Provider Demographics
NPI:1740247360
Name:GUNN, DOLORES J (MD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:J
Last Name:GUNN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1266 EDLOR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-3304
Mailing Address - Country:US
Mailing Address - Phone:314-983-0038
Mailing Address - Fax:
Practice Address - Street 1:2001 STATE ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-1803
Practice Address - Country:US
Practice Address - Phone:618-271-9191
Practice Address - Fax:618-271-9617
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO119796207Q00000X
IL036116296207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204715528Medicaid
MO204715528Medicaid