Healthcare Provider Details

I. General information

NPI: 1548363922
Provider Name (Legal Business Name): THOMAS E DUNAWAY MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 VESTER AVE
SPRINGFIELD OH
45503
US

IV. Provider business mailing address

1108 VESTER AVE
SPRINGFIELD OH
45503
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-7100
  • Fax: 937-399-7355
Mailing address:
  • Phone: 937-399-7100
  • Fax: 937-399-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35042438D
License Number StateOH

VIII. Authorized Official

Name: THOMAS E DUNAWAY
Title or Position: PRESIDENT
Credential: MD
Phone: 937-399-7100