Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | C52086 | CA |
N | 207YP0228X | Pediatric Otolaryngology | MD.207839 | LA |
NPI | 1427025675 |
---|---|
Provider Name | Michael E. Dunham |
First Address | Fresno, CA 93720-8022 |
Second Address | Baton Rouge, LA 70809-3738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D17925 | (02) | CA |