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Individual

REGINA Z GUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
5130 SOUTHPORT SUPPLY RD SE, STE 101, SOUTHPORT, NC 28461-9261
(910) 269-4053
(910) 363-4905
Mailing address
5130 SOUTHPORT SUPPLY RD SE, STE 101, SOUTHPORT, NC 28461-9261
(910) 269-4053
(910) 363-4905

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0010-06084
NC
363AM0700X
Medical Physician Assistant
301
WV

Other

Enumeration date
11/02/2005
Last updated
03/07/2017
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