Provider Demographics
NPI:1134102296
Name:DUNGAN, VINCENT CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:CRAIG
Last Name:DUNGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. DRAWER 1769
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-1769
Mailing Address - Country:US
Mailing Address - Phone:601-703-9506
Mailing Address - Fax:601-703-3264
Practice Address - Street 1:1800 12TH ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4158
Practice Address - Country:US
Practice Address - Phone:601-703-9541
Practice Address - Fax:601-703-9947
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12833207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009937735Medicaid
731-04039OtherBLUE CROSS OF AL
P00070814OtherRAILROAD MEDICARE
MS00112842Medicaid
MS00112842Medicaid
AL009937735Medicaid