1417046160 NPI number — LEVETTE NICOLE DUNBAR MD

Table of content: LEVETTE NICOLE DUNBAR MD (NPI 1417046160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417046160 NPI number — LEVETTE NICOLE DUNBAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNBAR
Provider First Name:
LEVETTE
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417046160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15260 NW 147TH DR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
ALACHUA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32615-5339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-9120
Provider Business Mailing Address Fax Number:
352-392-8725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1702 S JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32348-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-577-5437
Provider Business Practice Location Address Fax Number:
850-838-2140
Provider Enumeration Date:
10/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  ME91334 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME91334 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 278596000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".