Provider Demographics
NPI:1104094762
Name:JOCELYN B DUNHAM, MD,PA
Entity type:Organization
Organization Name:JOCELYN B DUNHAM, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-724-0500
Mailing Address - Street 1:3041 CHURCHILL DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2706
Mailing Address - Country:US
Mailing Address - Phone:972-724-0500
Mailing Address - Fax:972-724-0501
Practice Address - Street 1:3041 CHURCHILL DR
Practice Address - Street 2:SUITE 500
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2706
Practice Address - Country:US
Practice Address - Phone:972-724-0500
Practice Address - Fax:972-724-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF84124Medicare UPIN
TX00832WMedicare PIN