Provider Demographics
NPI:1295705176
Name:DUNAWAY, DAN ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:ALEXANDER
Last Name:DUNAWAY
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 1:5210 POPLAR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3515
Mailing Address - Country:US
Mailing Address - Phone:901-761-0685
Mailing Address - Fax:901-761-0688
Practice Address - Street 1:5210 POPLAR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3515
Practice Address - Country:US
Practice Address - Phone:901-761-0685
Practice Address - Fax:901-761-0688
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5706207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3144214Medicaid
TN3380998Medicare ID - Type Unspecified
TN3144214Medicaid