Provider Demographics
NPI:1962842104
Name:DUNKLE, CLINTON RYAN (DO)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:RYAN
Last Name:DUNKLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8318
Mailing Address - Fax:417-347-8316
Practice Address - Street 1:3202 MCINTOSH CIR STE 201
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3686
Practice Address - Country:US
Practice Address - Phone:417-347-8318
Practice Address - Fax:417-347-8316
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014041288208M00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist