Provider Demographics
NPI:1073629127
Name:DUNN, LUCKEY M (MD)
Entity type:Individual
Prefix:
First Name:LUCKEY
Middle Name:M
Last Name:DUNN
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 1:155 S HALIFAX AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-4481
Mailing Address - Country:US
Mailing Address - Phone:386-252-7119
Mailing Address - Fax:386-253-5518
Practice Address - Street 1:155 S HALIFAX AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-4481
Practice Address - Country:US
Practice Address - Phone:386-252-7119
Practice Address - Fax:386-253-5518
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061043207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD04517Medicare UPIN
FL14851VMedicare ID - Type Unspecified