Provider Demographics
NPI:1629177712
Name:DM AND C
Entity Type:Organization
Organization Name:DM AND C
Other - Org Name:DAVIN R. LUNDQUIST, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUNDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-849-1236
Mailing Address - Street 1:376A SIMPSON HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:MAGEE
Mailing Address - State:MS
Mailing Address - Zip Code:39111-3409
Mailing Address - Country:US
Mailing Address - Phone:601-849-1236
Mailing Address - Fax:601-849-1240
Practice Address - Street 1:376A SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MAGEE
Practice Address - State:MS
Practice Address - Zip Code:39111-3409
Practice Address - Country:US
Practice Address - Phone:601-849-1236
Practice Address - Fax:601-849-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03505561Medicaid
MS03505561Medicaid
MSH91835Medicare UPIN
MS5628900001Medicare NSC
MSC03404Medicare PIN