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General NPI Number Information
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NPI Number | 1245632108
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Entity Type | Organization
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Legal Business Name | DWAYNE DUNLAP PLLC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 6026 YORKTOWN MEADOW LN
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City | HOUSTON
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State | TX
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Zip | 77084-6818
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Country | US
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Telephone | 248-346-2748
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Fax |
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Provider Business Mailing Address
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Address Line | 6026 YORKTOWN MEADOW LN
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City | HOUSTON
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State | TX
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Zip | 77084-6818
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Country | US
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Telephone | 248-346-2748
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Fax |
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Authorized Official
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Title or Position | SURGICAL ASSISTANT
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Name | MR. DWAYNE DUNLAP
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Credential | LSA
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Telephone | 248-346-2748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | SA00368
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License Number State | TX
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