1487624896 NPI number — DR. JOHN C DUNHAM M.D.

Table of content: DR. JOHN C DUNHAM M.D. (NPI 1487624896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487624896 NPI number — DR. JOHN C DUNHAM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNHAM
Provider First Name:
JOHN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1487624896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72830-0668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-754-8384
Provider Business Mailing Address Fax Number:
479-754-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W MCKENNON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72830-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-754-8384
Provider Business Practice Location Address Fax Number:
479-754-7141
Provider Enumeration Date:
01/26/2006

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: 207Q00000X , with the licence number:  C7475 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0062731 . This is a "UMWA H&R FUND" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 434592 . This is a "HEALTH LINK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 54238 . This is a "BLUECROSSBLUESHIELD ARK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 15354000000 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 0790780001 . This is a "PALMETTO GBA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: XX12984 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1670797 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 4211419 . This is a "AETNA INSURANCE COMPANY" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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