Provider Demographics
NPI:1225352537
Name:DUNN, G. MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:G.
Middle Name:MICHAEL
Last Name:DUNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:S
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:17510 88TH STREET KP S
Mailing Address - Street 2:
Mailing Address - City:LONGBRANCH
Mailing Address - State:WA
Mailing Address - Zip Code:98351-9630
Mailing Address - Country:US
Mailing Address - Phone:352-443-9015
Mailing Address - Fax:
Practice Address - Street 1:17510 88TH STREET KP S
Practice Address - Street 2:
Practice Address - City:LONGBRANCH
Practice Address - State:WA
Practice Address - Zip Code:98351-9630
Practice Address - Country:US
Practice Address - Phone:352-443-9015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9486207W00000X
WAOP 00001032207W00000X
FL94862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry