Provider Demographics
NPI:1245347582
Name:DUNN, E CHARISSE (DPM)
Entity type:Individual
Prefix:DR
First Name:E
Middle Name:CHARISSE
Last Name:DUNN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 PGA BLVD
Mailing Address - Street 2:STE 212
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3838
Mailing Address - Country:US
Mailing Address - Phone:561-776-7047
Mailing Address - Fax:561-776-7049
Practice Address - Street 1:5610 PGA BLVD
Practice Address - Street 2:STE 212
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3838
Practice Address - Country:US
Practice Address - Phone:561-776-7047
Practice Address - Fax:561-776-7049
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOOOO2182213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU29938Medicare UPIN
FL65236Medicare ID - Type Unspecified