Provider Demographics
NPI:1386803773
Name:CLARENCE BUTCH DUNN JR MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:CLARENCE BUTCH DUNN JR MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-322-2202
Mailing Address - Street 1:302 MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5324
Mailing Address - Country:US
Mailing Address - Phone:318-322-2202
Mailing Address - Fax:318-322-9949
Practice Address - Street 1:302 MCMILLAN RD
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5324
Practice Address - Country:US
Practice Address - Phone:318-322-2202
Practice Address - Fax:318-322-9949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021090207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DT03Medicare PIN