Provider Demographics
NPI:1427049121
Name:GUM, REGINA Z (PA-C)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:Z
Last Name:GUM
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Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:5130 SOUTHPORT SUPPLY RD SE
Mailing Address - Street 2:STE 101
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-9261
Mailing Address - Country:US
Mailing Address - Phone:910-269-4053
Mailing Address - Fax:910-363-4905
Practice Address - Street 1:5130 SOUTHPORT SUPPLY RD SE
Practice Address - Street 2:STE 101
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-9261
Practice Address - Country:US
Practice Address - Phone:910-269-4053
Practice Address - Fax:910-363-4905
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2017-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV301363AM0700X
NC0010-06084363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical