1457454837 NPI number — THOMAS E DUNAWAY MD

Table of content: THOMAS E DUNAWAY MD (NPI 1457454837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457454837 NPI number — THOMAS E DUNAWAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNAWAY
Provider First Name:
THOMAS
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1457454837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 E MAIN ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANDER
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82520-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-335-7720
Provider Business Mailing Address Fax Number:
307-335-7723

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
535 E MAIN ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANDER
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82520-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-335-7720
Provider Business Practice Location Address Fax Number:
307-335-7723
Provider Enumeration Date:
09/07/2006

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: 207V00000X , with the licence number:  35042438D , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 129852600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".