Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | 5706 | TN |
NPI | 1295705176 |
---|---|
Provider Name | Dan Alexander Dunaway |
First Address | Memphis, TN 38119-3515 |
Second Address | Memphis, TN 38119-3515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3144214 | (05) | TN |
B0264 | (02) | TN |