Provider Demographics
NPI:1235330804
Name:DUNN, MATTHEW LEE (NP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LEE
Last Name:DUNN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 COLLEGE STREET
Mailing Address - Street 2:3 SABINE/PROGRESSIVE CARE UNIT
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77704
Mailing Address - Country:US
Mailing Address - Phone:409-212-7303
Mailing Address - Fax:409-212-7301
Practice Address - Street 1:3080 COLLEGE ST
Practice Address - Street 2:3 SABINE/PROGRESSIVE CARE UNIT
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4606
Practice Address - Country:US
Practice Address - Phone:409-212-7303
Practice Address - Fax:409-212-7301
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX677880363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204499201Medicaid
TXP00729224OtherRAILROAD MEDICARE
TXP00729224OtherRAILROAD MEDICARE