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General NPI Number Information
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NPI Number | 1245595438
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Entity Type | Individual
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Provider Name | JEFFREY HOLTER DUNN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 559 VINCENT ST ATTN: 302 ASTS
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City | PETERSON AFB
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State | CO
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Zip | 80914-1540
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Country | US
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Telephone | 719-556-1132
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Fax | 719-556-1129
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Provider Business Mailing Address
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Address Line | 559 VINCENT ST ATTN: 302 ASTS
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City | PETERSON AFB
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State | CO
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Zip | 80914-1540
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Country | US
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Telephone | 719-556-1132
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Fax | 719-556-1129
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | DR.0052790
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License Number State | CO
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