=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649815671
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN W DUNKLE, MD PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2019
-----------------------------------------------------
Last Update Date | 11/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4320 SEMINARY RD
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-403-1351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5155 CALIFORNIA LN
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22304-8670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-982-6386
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JOHN WHITCOMB DUNKLE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 720-982-6386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------