Healthcare Provider Details

I. General information

NPI: 1265451199
Provider Name (Legal Business Name): DAVID B DUNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID BRUCE DUNN MD

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12400 OLIVE BLVD #203
SAINT LOUIS MO
63141-5454
US

IV. Provider business mailing address

1901 BUTTERFIELD RD SUITE 220
DOWNERS GROVE IL
60515-7915
US

V. Phone/Fax

Practice location:
  • Phone: 317-878-2100
  • Fax: 314-878-2107
Mailing address:
  • Phone: 630-725-2768
  • Fax: 630-725-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036065804
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberME102728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: