Provider Demographics
NPI:1205839834
Name:DUNN, DAN AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:AUSTIN
Last Name:DUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 E. 20TH STREET
Mailing Address - Street 2:PRIMARY HEALTHCARE, INC.
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-2105
Mailing Address - Country:US
Mailing Address - Phone:505-324-6300
Mailing Address - Fax:505-327-2218
Practice Address - Street 1:505 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-2105
Practice Address - Country:US
Practice Address - Phone:505-324-6300
Practice Address - Fax:505-327-2218
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM90-188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14710OtherPHP COMMERCIAL/SALUD
NM21258OtherLOVELACE HEALTH PLAN
NM3833OtherLOVELACE SALUD
NM33198Medicaid
NMNM014513OtherBCBS OF NEW MEXICO
NM3833OtherLOVELACE SALUD