Healthcare Provider Details

I. General information

NPI: 1184663106
Provider Name (Legal Business Name): DAVID KEITH DUNIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E BAKER ST
INDIANOLA MS
38751-2450
US

IV. Provider business mailing address

314 POINTE DR
STARKVILLE MS
39759-6224
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-5235
  • Fax:
Mailing address:
  • Phone: 662-324-9732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number10267
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: