Provider Demographics
NPI:1295809267
Name:DUNN, JOEMING WOLFE (MD)
Entity type:Individual
Prefix:
First Name:JOEMING
Middle Name:WOLFE
Last Name:DUNN
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:PO BOX 40218
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1218
Mailing Address - Country:US
Mailing Address - Phone:210-615-1331
Mailing Address - Fax:210-614-5029
Practice Address - Street 1:5815 CALLAGHAN RD
Practice Address - Street 2:STE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1103
Practice Address - Country:US
Practice Address - Phone:210-615-1331
Practice Address - Fax:210-614-5029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5568208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142935901Medicaid
TX142778301Medicaid
8608M0Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #