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General NPI Number Information
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NPI Number | 1699369199
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Entity Type | Organization
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Legal Business Name | BONNIE J DUNGAN MD LLC
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 1736 E MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36301-3040
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Country | US
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Telephone | 334-796-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 134 TELFORD PL
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City | DOTHAN
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State | AL
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Zip | 36305-6954
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Country | US
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Telephone | 334-796-2380
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | BONNIE J DUNGAN
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Credential | MD
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Telephone | 334-796-2328
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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