Provider Demographics
NPI:1356624852
Name:DAVID A. DUNWORTH, D.O., P.C.
Entity type:Organization
Organization Name:DAVID A. DUNWORTH, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DUNWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-215-1120
Mailing Address - Street 1:802 E NAVAJO ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9119
Mailing Address - Country:US
Mailing Address - Phone:505-215-1120
Mailing Address - Fax:
Practice Address - Street 1:802 E NAVAJO ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9119
Practice Address - Country:US
Practice Address - Phone:505-215-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-111099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDT0793OtherRR MEDICARE
NM93151870Medicaid
NMF91117Medicare UPIN
NM93151870Medicaid