Healthcare Provider Details

I. General information

NPI: 1205821865
Provider Name (Legal Business Name): CP DUNBAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 E COLUMBIA AVE
LEESVILLE SC
29070-7318
US

IV. Provider business mailing address

517 LITTLE CREEK DR
LEESVILLE SC
29070-7418
US

V. Phone/Fax

Practice location:
  • Phone: 803-532-8155
  • Fax:
Mailing address:
  • Phone: 803-532-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11846
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: