Healthcare Provider Details

I. General information

NPI: 1154818789
Provider Name (Legal Business Name): ROBERT DUNIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKVIEW PL
SAINT LOUIS MO
63110-1038
US

IV. Provider business mailing address

22 N EUCLID AVE STE 233
SAINT LOUIS MO
63108-1407
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3117
  • Fax:
Mailing address:
  • Phone: 314-362-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: