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General NPI Number Information
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NPI Number | 1356624852
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Entity Type | Organization
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Legal Business Name | DAVID A. DUNWORTH, D.O., P.C.
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 802 E NAVAJO ST
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City | FARMINGTON
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State | NM
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Zip | 87401-9119
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Country | US
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Telephone | 505-215-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 802 E NAVAJO ST
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City | FARMINGTON
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State | NM
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Zip | 87401-9119
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Country | US
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Telephone | 505-215-1120
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Fax |
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Authorized Official
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Title or Position | SURGEON
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Name | DAVID ALAN DUNWORTH
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Credential | D.O.
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Telephone | 505-215-1120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A-111099
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License Number State | NM
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