Provider Demographics
NPI:1699369199
Name:BONNIE J DUNGAN MD LLC
Entity type:Organization
Organization Name:BONNIE J DUNGAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-796-2328
Mailing Address - Street 1:134 TELFORD PL
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-6954
Mailing Address - Country:US
Mailing Address - Phone:334-796-2380
Mailing Address - Fax:
Practice Address - Street 1:1736 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3040
Practice Address - Country:US
Practice Address - Phone:334-796-2380
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit