Healthcare Provider Details

I. General information

NPI: 1225352537
Provider Name (Legal Business Name): G. MICHAEL DUNN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL S DUNN D.O.

II. Dates (important events)

Enumeration Date: 03/16/2010
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17510 88TH STREET KP S
LONGBRANCH WA
98351-9630
US

IV. Provider business mailing address

17510 88TH STREET KP S
LONGBRANCH WA
98351-9630
US

V. Phone/Fax

Practice location:
  • Phone: 352-443-9015
  • Fax:
Mailing address:
  • Phone: 352-443-9015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS 9486
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOP 00001032
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9486
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: