Provider Demographics
NPI:1972593457
Name:DUMLAO, DONATO G (MD)
Entity Type:Individual
Prefix:
First Name:DONATO
Middle Name:G
Last Name:DUMLAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:29653 ANCHOR CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9594
Mailing Address - Country:US
Mailing Address - Phone:251-625-6896
Mailing Address - Fax:251-625-6897
Practice Address - Street 1:29653 ANCHOR CROSS BLVD
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9594
Practice Address - Country:US
Practice Address - Phone:251-625-6896
Practice Address - Fax:251-625-6897
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL25803207RH0002X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02710456Medicaid
NYH48676Medicare UPIN
NY02710456Medicaid
AL510I110283Medicare PIN