Provider Demographics
NPI:1467564237
Name:DUNLAP, GARY ALLEN (DO)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:ALLEN
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-3147
Mailing Address - Country:US
Mailing Address - Phone:937-253-6741
Mailing Address - Fax:937-253-2431
Practice Address - Street 1:2640 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-3147
Practice Address - Country:US
Practice Address - Phone:937-253-6741
Practice Address - Fax:937-253-2431
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2045208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217072Medicaid
CF16837Medicare UPIN
OHDU0378871Medicare ID - Type Unspecified