Provider Demographics
NPI:1518960210
Name:DUNHAM, JOCELYN B (MD PA)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:B
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3041 CHURCHILL DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2706
Mailing Address - Country:US
Mailing Address - Phone:972-724-0500
Mailing Address - Fax:972-724-0501
Practice Address - Street 1:3041 CHURCHILL DR
Practice Address - Street 2:SUITE 500
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2706
Practice Address - Country:US
Practice Address - Phone:972-724-0500
Practice Address - Fax:972-724-0501
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9382Medicare PIN
TXF84124Medicare UPIN