Healthcare Provider Details

I. General information

NPI: 1053030130
Provider Name (Legal Business Name): J DUNCKELMEYER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 S PARKER ST STE 150
ORANGE CA
92868-4761
US

IV. Provider business mailing address

22 OLIVE RIDGE DR
LAS VEGAS NV
89135-7892
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-0900
  • Fax: 714-744-9232
Mailing address:
  • Phone: 702-768-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORG DUNCKELMEYER
Title or Position: PRESIDENT
Credential: MD
Phone: 702-768-5875