Provider Demographics
NPI:1457314221
Name:DUNN, JENNIFER MARTENS (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARTENS
Last Name:DUNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11 GARVEY PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5614
Mailing Address - Country:US
Mailing Address - Phone:636-441-7280
Mailing Address - Fax:636-939-9208
Practice Address - Street 1:11 GARVEY PKWY
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5614
Practice Address - Country:US
Practice Address - Phone:636-441-7280
Practice Address - Fax:636-939-9208
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003012269208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200003381Medicaid