Provider Demographics
NPI:1124046560
Name:JAMES SANDIDGE DUNN JR MD INC
Entity Type:Organization
Organization Name:JAMES SANDIDGE DUNN JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:530-886-6660
Mailing Address - Street 1:11795 EDUCATION ST
Mailing Address - Street 2:SUITE 222
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2469
Mailing Address - Country:US
Mailing Address - Phone:530-886-6660
Mailing Address - Fax:530-886-6656
Practice Address - Street 1:11795 EDUCATION ST
Practice Address - Street 2:SUITE 222
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2469
Practice Address - Country:US
Practice Address - Phone:530-886-6660
Practice Address - Fax:530-886-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84568207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A845680Medicaid
H18994Medicare UPIN
CAZZZ02474ZMedicare PIN