Provider Demographics
NPI:1811058241
Name:GUNN, MATTHEW PETER (PA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:PETER
Last Name:GUNN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:5448 WIND MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1447
Mailing Address - Country:US
Mailing Address - Phone:919-622-0956
Mailing Address - Fax:
Practice Address - Street 1:DUKE UNIVERSITY MEDICAL CTR
Practice Address - Street 2:ERWIN ROAD
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102035363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ48041Medicare UPIN