Provider Demographics
NPI:1598938318
Name:DUNHAM, DOUGLAS L (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:DUNHAM
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 1:401 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1931
Mailing Address - Country:US
Mailing Address - Phone:406-563-8500
Mailing Address - Fax:406-563-8694
Practice Address - Street 1:401 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1931
Practice Address - Country:US
Practice Address - Phone:406-563-8500
Practice Address - Fax:406-563-8694
Is Sole Proprietor?:No
Enumeration Date:2008-04-13
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12722207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12722OtherSTATE LICENSE