Provider Demographics
NPI:1952583213
Name:DAVID C NUNLEY RADIOLOGY INC
Entity Type:Organization
Organization Name:DAVID C NUNLEY RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NUNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-748-1116
Mailing Address - Street 1:1680 S CENTRAL BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7395
Mailing Address - Country:US
Mailing Address - Phone:561-748-1116
Mailing Address - Fax:561-748-2997
Practice Address - Street 1:1680 S CENTRAL BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7395
Practice Address - Country:US
Practice Address - Phone:561-748-1116
Practice Address - Fax:561-748-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90263174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272766800Medicaid
FLK7610Medicare PIN
FL272766800Medicaid