Provider Demographics
NPI:1609464478
Name:DUNN, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:DUNN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1144
Mailing Address - Street 2:
Mailing Address - City:POTH
Mailing Address - State:TX
Mailing Address - Zip Code:78147-1144
Mailing Address - Country:US
Mailing Address - Phone:210-289-6984
Mailing Address - Fax:
Practice Address - Street 1:113 E MAIN ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:TX
Practice Address - Zip Code:78164
Practice Address - Country:US
Practice Address - Phone:361-564-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist