Provider Demographics
NPI:1417450552
Name:DUNBAR, MARCELLOUS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCELLOUS
Middle Name:
Last Name:DUNBAR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 E HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2706
Mailing Address - Country:US
Mailing Address - Phone:817-676-3523
Mailing Address - Fax:
Practice Address - Street 1:920 E HWY 67
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-7513
Practice Address - Country:US
Practice Address - Phone:469-930-9967
Practice Address - Fax:972-298-2411
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No385H00000XRespite Care FacilityRespite Care