Healthcare Provider Details

I. General information

NPI: 1871132548
Provider Name (Legal Business Name): ANTHONY CLARK DUNNING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2019
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7746 RANNELLS AVE
SAINT LOUIS MO
63143-1823
US

IV. Provider business mailing address

5856 S LOWELL BLVD UNIT 32 #403
LITTLETON CO
80123-7915
US

V. Phone/Fax

Practice location:
  • Phone: 636-266-4159
  • Fax: 303-922-4636
Mailing address:
  • Phone: 217-821-0759
  • Fax: 303-922-4640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: