Healthcare Provider Details

I. General information

NPI: 1487624896
Provider Name (Legal Business Name): JOHN C DUNHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MCKENNON ST
CLARKSVILLE AR
72830-3523
US

IV. Provider business mailing address

PO BOX 668
CLARKSVILLE AR
72830-0668
US

V. Phone/Fax

Practice location:
  • Phone: 479-754-8384
  • Fax: 479-754-7141
Mailing address:
  • Phone: 479-754-8384
  • Fax: 479-754-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC7475
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: