Provider Demographics
NPI:1952308405
Name:DUNN, SCOTT RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RONALD
Last Name:DUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N THIRD AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1594
Mailing Address - Country:US
Mailing Address - Phone:208-263-1435
Mailing Address - Fax:
Practice Address - Street 1:606 N THIRD AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1594
Practice Address - Country:US
Practice Address - Phone:208-263-1435
Practice Address - Fax:208-263-4580
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM5940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002792300Medicaid
080152758Medicare PIN
ID002792300Medicaid
IDF27705Medicare UPIN