Provider Demographics
NPI:1245271832
Name:DUNLAP, EDDIE RAY (CRNA)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:RAY
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:EDDIE
Other - Middle Name:R
Other - Last Name:DUNLAP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA, MS, PC
Mailing Address - Street 1:282 W RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-4797
Mailing Address - Country:US
Mailing Address - Phone:940-626-4505
Mailing Address - Fax:940-626-4905
Practice Address - Street 1:2000 S FM 51
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3702
Practice Address - Country:US
Practice Address - Phone:940-627-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254134367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9807Medicare PIN