Provider Demographics
NPI:1053418152
Name:DUNN, CHARLES W (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:DUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1222 S DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:1222 S DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0204
Practice Address - Country:US
Practice Address - Phone:417-860-7743
Practice Address - Fax:417-269-7567
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9N082086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118554001Medicaid
MO202933115Medicaid
MOB87604Medicare UPIN
MO202933115Medicaid