Provider Demographics
NPI:1427235639
Name:LARRY W DUNKERLEY DPM PC
Entity type:Organization
Organization Name:LARRY W DUNKERLEY DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DUNKERLY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PC
Authorized Official - Phone:972-875-6320
Mailing Address - Street 1:800 W LAMPASAS
Mailing Address - Street 2:STE A
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-4536
Mailing Address - Country:US
Mailing Address - Phone:972-875-6320
Mailing Address - Fax:972-875-6332
Practice Address - Street 1:800 W LAMPASAS
Practice Address - Street 2:STE A
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-4536
Practice Address - Country:US
Practice Address - Phone:972-875-6320
Practice Address - Fax:972-875-6332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0419213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153604701Medicaid
TX153604701Medicaid