Provider Demographics
NPI:1275759821
Name:DEASON C. DUNAGAN MD, PC
Entity Type:Organization
Organization Name:DEASON C. DUNAGAN MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEASON
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUNAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-4448
Mailing Address - Street 1:303 WILLIAMS AVE SW
Mailing Address - Street 2:SUITE 1421
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6012
Mailing Address - Country:US
Mailing Address - Phone:256-536-4448
Mailing Address - Fax:256-533-4583
Practice Address - Street 1:303 WILLIAMS AVE SW
Practice Address - Street 2:SUITE 1421
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6012
Practice Address - Country:US
Practice Address - Phone:256-536-4448
Practice Address - Fax:256-533-4583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL86422086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000003965Medicaid
ALC75667Medicare UPIN
AL000003965Medicaid