Provider Demographics
NPI:1881722593
Name:NEAL ALLAN DUNITZ, MD
Entity type:Organization
Organization Name:NEAL ALLAN DUNITZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:DUNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-940-4806
Mailing Address - Street 1:2525 SW PATTON RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-1647
Mailing Address - Country:US
Mailing Address - Phone:503-940-4806
Mailing Address - Fax:503-841-5108
Practice Address - Street 1:2525 SW PATTON RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-1647
Practice Address - Country:US
Practice Address - Phone:503-940-4806
Practice Address - Fax:503-841-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR068564Medicaid
WA8212961Medicaid
OR288287Medicaid
OR1200233-4OtherBIN
OR068564Medicaid
OR288287Medicaid