Provider Demographics
NPI:1336493055
Name:DUNLAP, BRENDAN ANDREW (PA-C)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:ANDREW
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 FM 3514
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-7635
Mailing Address - Country:US
Mailing Address - Phone:409-722-5255
Mailing Address - Fax:
Practice Address - Street 1:3060 FM 3514
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-7635
Practice Address - Country:US
Practice Address - Phone:409-722-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08003363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical