Provider Demographics
NPI:1356525208
Name:DUNHAM, DEBORAH ANN
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 9TH AVE W#140
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221
Mailing Address - Country:US
Mailing Address - Phone:941-526-6760
Mailing Address - Fax:
Practice Address - Street 1:1180 8TH AVE W # 140
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-3810
Practice Address - Country:US
Practice Address - Phone:941-526-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6930956Medicaid