Provider Demographics
NPI:1205821865
Name:DUNBAR, CP (MD)
Entity Type:Individual
Prefix:
First Name:CP
Middle Name:
Last Name:DUNBAR
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 1:517 LITTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29070-7418
Mailing Address - Country:US
Mailing Address - Phone:803-532-5859
Mailing Address - Fax:
Practice Address - Street 1:608 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-7318
Practice Address - Country:US
Practice Address - Phone:803-532-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC118465Medicaid
SCB92140Medicare UPIN