Healthcare Provider Details

I. General information

NPI: 1033504147
Provider Name (Legal Business Name): AARON DUNHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W CHERRY LANE STE 204
MERIDIAN ID
83642
US

IV. Provider business mailing address

3340 E GOLDSTONE DR
MERIDIAN ID
83642
US

V. Phone/Fax

Practice location:
  • Phone: 208-302-3300
  • Fax: 208-302-3355
Mailing address:
  • Phone: 208-302-3300
  • Fax: 208-302-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD199781
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM-15166
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0600004379
License Number StateVT
# 4
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberM-15166
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: