Provider Demographics
NPI:1588668065
Name:DUNN-BLACK, RACHEL R (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:DUNN-BLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 RANCH LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097
Mailing Address - Country:US
Mailing Address - Phone:530-842-3261
Mailing Address - Fax:530-842-7899
Practice Address - Street 1:475 BRUCE STREET
Practice Address - Street 2:SUITE 700
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097
Practice Address - Country:US
Practice Address - Phone:530-842-3261
Practice Address - Fax:530-842-7899
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA60372207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080090464OtherRAILROAD MEDICARE NUMBER
G27324Medicare UPIN
CA00A603720Medicare ID - Type UnspecifiedMEDICARE NUMBER