Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | R9N08 | MO |
NPI | 1053418152 |
---|---|
Provider Name | Charles W Dunn |
First Address | Kansas City, MO 64180-2843 |
Second Address | Springfield, MO 65807-5249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
118554001 | (05) | AR |
202933115 | (05) | MO |