Provider Demographics
NPI:1386760080
Name:GUNN, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GUNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 DOUGHTY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5727
Mailing Address - Country:US
Mailing Address - Phone:843-577-6791
Mailing Address - Fax:843-577-0553
Practice Address - Street 1:125 DOUGHTY ST STE 200
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5727
Practice Address - Country:US
Practice Address - Phone:843-577-6791
Practice Address - Fax:843-577-0553
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01042207RC0200X
SC31487207RP1001X, 207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC314877Medicaid
NC1386760080Medicaid
SC314877Medicaid
SC314877Medicaid
SCP00925472OtherRR MEDICARE-RHI
NCNCK219AMedicare PIN