Provider Demographics
NPI:1831178870
Name:DUNGAN, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:DUNGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1809 ADAMS ST
Practice Address - Street 2:MANKATO CLINIC AT ADAMS STREET
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4841
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN43640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0111781OtherMEDICA
MNNA2951027672OtherPREFERRED ONE
MNHP33924OtherHEALTH PARTNERS
MN140738OtherUCARE
MN45D91DUOtherBCBS
MN1965888OtherAMERICAS PPO
MN627645800Medicaid
930110343OtherRR MEDICARE
MN45D91DUOtherBCBS
MN080010373Medicare PIN