Provider Demographics
NPI:1740266535
Name:DUNAWAY, GEOFFREY LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:LAWRENCE
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 1:406 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3517
Mailing Address - Country:US
Mailing Address - Phone:870-741-3252
Mailing Address - Fax:870-741-3962
Practice Address - Street 1:406 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3517
Practice Address - Country:US
Practice Address - Phone:870-741-3252
Practice Address - Fax:870-741-3962
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR51456Medicare ID - Type Unspecified
D04502Medicare UPIN