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NPI Code Detail

MEDICARE: MRS. AVEGIYEL ELLIS DUNN DO

MEDICARE: MRS. AVEGIYEL ELLIS DUNN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianP1987TX

General Provider Information

NPI Number : 1417224338
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. AVEGIYEL ELLIS DUNN DO
Provider Business Mailing Address
First Line : 2413 MEMORIAL PKWY
Second Line :
City : PORTLAND
State : TX
Zip : 78374-3209
Country : US
Telephone Number : 361-758-5326
Fax Number : 361-758-2137
Provider Business Practice Location Address
First Line : 2413 MEMORIAL PKWY
Second Line :
City : PORTLAND
State : TX
Zip : 78374-3209
Country : US
Telephone Number : 361-758-5326
Fax Number : 361-758-2137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2011
Last Update Date : 08/20/2021

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