Provider Demographics
NPI:1285777383
Name:DUNAGAN, MARY ANNETTE (PA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNETTE
Last Name:DUNAGAN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:100 S MAIN ST
Mailing Address - Street 2:#B
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5369
Mailing Address - Country:US
Mailing Address - Phone:918-423-3700
Mailing Address - Fax:918-423-3712
Practice Address - Street 1:100 S MAIN ST
Practice Address - Street 2:#B
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5369
Practice Address - Country:US
Practice Address - Phone:918-423-3700
Practice Address - Fax:918-423-3712
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2011-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OKPA536363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS64403Medicare UPIN