Healthcare Provider Details

I. General information

NPI: 1902866353
Provider Name (Legal Business Name): WILLIAM PAUL DUNHAM ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S DENTON TAP RD STE 100
COPPELL TX
75019
US

IV. Provider business mailing address

601 N PARK BLVD APT 2406
GRAPEVINE TX
76051-7833
US

V. Phone/Fax

Practice location:
  • Phone: 972-304-9100
  • Fax: 972-304-9048
Mailing address:
  • Phone: 817-251-2085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT2254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: