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NPI Code Detail

MEDICARE: DWAYNE DUNLAP PLLC

MEDICARE: DWAYNE DUNLAP PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantSA00368TX

General Provider Information

NPI Number : 1245632108
Entity Type Code : Organization
Provider Name (Legal Business Name) : DWAYNE DUNLAP PLLC
Provider Business Mailing Address
First Line : 6026 YORKTOWN MEADOW LN
Second Line :
City : HOUSTON
State : TX
Zip : 77084-6818
Country : US
Telephone Number : 248-346-2748
Fax Number :
Provider Business Practice Location Address
First Line : 6026 YORKTOWN MEADOW LN
Second Line :
City : HOUSTON
State : TX
Zip : 77084-6818
Country : US
Telephone Number : 248-346-2748
Fax Number :
Authorized Official
Title or Position : SURGICAL ASSISTANT
Name : MR. DWAYNE DUNLAP
Credential : LSA
Telephone Number : 248-346-2748
Provider Enumeration Date : 09/23/2014
Last Update Date : 11/07/2014

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