=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871132548
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY CLARK DUNNING
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2019
-----------------------------------------------------
Last Update Date | 12/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7746 RANNELLS AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63143-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-266-4159
-----------------------------------------------------
Fax | 303-922-4636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5856 S LOWELL BLVD UNIT 32 #403
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80123-7915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-821-0759
-----------------------------------------------------
Fax | 303-922-4640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZE0600X
-----------------------------------------------------
Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------