Provider Demographics
NPI:1245754449
Name:S DUNKELBERGER DO LLC
Entity Type:Organization
Organization Name:S DUNKELBERGER DO LLC
Other - Org Name:G ROGER DUNKELBERGER DO LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNKELBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-592-1919
Mailing Address - Street 1:6801 GULFPORT BLVD S.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707
Mailing Address - Country:US
Mailing Address - Phone:727-592-1919
Mailing Address - Fax:727-800-6989
Practice Address - Street 1:6801 GULFPORT BLVD S.
Practice Address - Street 2:SUITE 6
Practice Address - City:SOUT PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707
Practice Address - Country:US
Practice Address - Phone:727-592-1919
Practice Address - Fax:727-800-6989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-29
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL059215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty