Provider Demographics
NPI:1033119763
Name:DUNLOP, COLLEEN MICHELE JR (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:MICHELE
Last Name:DUNLOP
Suffix:JR
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:MICHELE
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:7324 SOUTHWEST FREEWAY
Mailing Address - Street 2:SUITE 1550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2053
Mailing Address - Country:US
Mailing Address - Phone:713-779-9800
Mailing Address - Fax:713-779-9813
Practice Address - Street 1:7324 SOUTHWEST FREEWAY
Practice Address - Street 2:SUITE 1550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2053
Practice Address - Country:US
Practice Address - Phone:713-779-9800
Practice Address - Fax:713-779-9813
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001342363AS0400X
IN10000991A363AS0400X
IL085.001342363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01618941OtherBLUECROSS/BLUESHIELD
ILK19508Medicare PIN
IL01618941OtherBLUECROSS/BLUESHIELD
ILP09531Medicare UPIN
IN408430CCMedicare PIN
ILK19016Medicare PIN