Provider Demographics
NPI:1659910412
Name:DUNLAP, COLTON DOUGLAS (RDN)
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:DOUGLAS
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 E 134TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-2244
Mailing Address - Country:US
Mailing Address - Phone:918-260-1081
Mailing Address - Fax:
Practice Address - Street 1:1306 E 134TH PL
Practice Address - Street 2:
Practice Address - City:GLENPOOL
Practice Address - State:OK
Practice Address - Zip Code:74033-2244
Practice Address - Country:US
Practice Address - Phone:918-260-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2457133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered