Provider Demographics
NPI:1558540708
Name:DUNDON, BRUCE C (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:C
Last Name:DUNDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:STE 312 HAYGOOD MEDICAL CENTER
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455
Mailing Address - Country:US
Mailing Address - Phone:757-460-1124
Mailing Address - Fax:757-460-0359
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:STE 312 HAYGOOD MEDICAL CENTER
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455
Practice Address - Country:US
Practice Address - Phone:757-460-1124
Practice Address - Fax:757-460-0359
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026335207N00000X
VA026335174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB06946Medicare UPIN