Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101-046029 | VA |
NPI | 1073597365 |
---|---|
Provider Name | Dr. Ralph O Dunker |
First Address | Roanoke, VA 24015-4503 |
Second Address | Roanoke, VA 24016-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010019125 | (05) | VA |
1073597365 | (05) | VA |
A72672 | (02) | VA |