Individual
RYAN R GUNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 840698, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
706355
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202183402
—
TX
01
—
75-2616977-042
TRICARE
TX
01
—
892N40
BCBS
TX
01
—
P01200575
RAIL ROAD
TX
Enumeration date
04/29/2008
Last updated
04/01/2016
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