Provider Demographics
NPI:1417224338
Name:DUNN, AVEGIYEL ELLIS (DO)
Entity Type:Individual
Prefix:MRS
First Name:AVEGIYEL
Middle Name:ELLIS
Last Name:DUNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2413 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3209
Mailing Address - Country:US
Mailing Address - Phone:361-758-5326
Mailing Address - Fax:361-758-2137
Practice Address - Street 1:2413 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3209
Practice Address - Country:US
Practice Address - Phone:361-758-5326
Practice Address - Fax:361-758-2137
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine