Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 036.116260 | IL |
N | 207SG0201X | Clinical Genetics (M.D.) | K5911 | TX |
Y | 207V00000X | Obstetrician & Gynecologist | 036.116260 | IL |
N | 207V00000X | Obstetrician & Gynecologist | K5911 | TX |
NPI | 1790795979 |
---|---|
Provider Name | Mr. Jeffrey S Dungan |
First Address | Chicago, IL 60611-2914 |
Second Address | Chicago, IL 60611-5966 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 27/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E999958 | (02) | TX |