Provider Demographics
NPI:1376538512
Name:DUNN CHANDLER, MAREN J (DO)
Entity Type:Individual
Prefix:MS
First Name:MAREN
Middle Name:J
Last Name:DUNN CHANDLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 TOWN CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-1713
Mailing Address - Country:US
Mailing Address - Phone:406-995-6995
Mailing Address - Fax:
Practice Address - Street 1:334 TOWN CENTER AVE
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716-1713
Practice Address - Country:US
Practice Address - Phone:406-995-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1376538512Medicaid
ID807252900Medicaid