Provider Demographics
NPI:1992902167
Name:GARY P. NUNN M.D. P. A.
Entity type:Organization
Organization Name:GARY P. NUNN M.D. P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-375-3326
Mailing Address - Street 1:1024 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3824
Mailing Address - Country:US
Mailing Address - Phone:501-375-3326
Mailing Address - Fax:501-375-4245
Practice Address - Street 1:1024 SCOTT ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-3824
Practice Address - Country:US
Practice Address - Phone:501-375-3326
Practice Address - Fax:501-375-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3635207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50652Medicare ID - Type Unspecified
ARC67882Medicare UPIN