Provider Demographics
NPI:1598764003
Name:NUNLEY, DAVID CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:NUNLEY
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 1:1680 S CENTRAL BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7395
Mailing Address - Country:US
Mailing Address - Phone:561-748-1116
Mailing Address - Fax:561-748-2997
Practice Address - Street 1:1680 S CENTRAL BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7395
Practice Address - Country:US
Practice Address - Phone:561-748-1116
Practice Address - Fax:561-748-2997
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2012-02-22
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
FLME90263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH89298Medicare UPIN
FLU4702ZMedicare PIN