Healthcare Provider Details

I. General information

NPI: 1124744776
Provider Name (Legal Business Name): ST. LUKE'S SURGICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 COEUR DALENE CIR
EL PASO TX
79922-2133
US

IV. Provider business mailing address

706 COEUR DALENE CIR
EL PASO TX
79922-2133
US

V. Phone/Fax

Practice location:
  • Phone: 915-603-2775
  • Fax:
Mailing address:
  • Phone: 915-603-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN CHRISTOPHER DUNN
Title or Position: PRESIDENT
Credential: MD
Phone: 915-603-2775