Healthcare Provider Details

I. General information

NPI: 1689775884
Provider Name (Legal Business Name): MARTIN J DUNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 MARQUESAS CIRCLE
SARASOTA FL
34233
US

IV. Provider business mailing address

5575 MARQUESAS CIRCLE
SARASOTA FL
34233
US

V. Phone/Fax

Practice location:
  • Phone: 941-924-8080
  • Fax: 941-924-8089
Mailing address:
  • Phone: 941-924-8080
  • Fax: 941-924-8089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME81031
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME81031
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME81031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: