Provider Demographics
NPI:1073511572
Name:GUNN, STEPHEN EDWARD (PA-C)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:GUNN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DRIVE
Mailing Address - Street 2:SE 500 GH
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242
Mailing Address - Country:US
Mailing Address - Phone:319-356-3440
Mailing Address - Fax:319-356-3891
Practice Address - Street 1:200 HAWKINS DRIVE
Practice Address - Street 2:SE 500 GH
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-356-3440
Practice Address - Fax:319-356-3891
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001403363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAR22238Medicare UPIN
IAI5913Medicare ID - Type Unspecified