Provider Demographics
NPI:1225387467
Name:DUNLAP, ROBERT DALE
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 HOUSTON AVE SW
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-2207
Mailing Address - Country:US
Mailing Address - Phone:386-249-3140
Mailing Address - Fax:386-362-1814
Practice Address - Street 1:216 HOUSTON AVE SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2207
Practice Address - Country:US
Practice Address - Phone:386-249-3140
Practice Address - Fax:386-362-1814
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies