Provider Demographics
NPI:1699367383
Name:DUNLAP, BONNIE R (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:R
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:PROF
Other - First Name:BONNIE
Other - Middle Name:R
Other - Last Name:BURRAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BONNIE RUTH BURRAGE
Mailing Address - Street 1:330 WIEGEL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2961
Mailing Address - Country:US
Mailing Address - Phone:314-755-2273
Mailing Address - Fax:
Practice Address - Street 1:330 WIEGEL DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63135-2961
Practice Address - Country:US
Practice Address - Phone:314-755-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5335271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine