Provider Demographics
NPI:1396794467
Name:DUNBAR, MARVIN JR (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:DUNBAR
Suffix:JR
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 1:104 COUNTRY COVE LANE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9755
Mailing Address - Country:US
Mailing Address - Phone:601-856-1990
Mailing Address - Fax:
Practice Address - Street 1:104 COUNTRY COVE LANE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-9755
Practice Address - Country:US
Practice Address - Phone:601-856-1990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17276207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125232Medicaid
MSH55879Medicare UPIN