Provider Demographics
NPI:1992811277
Name:DERMATOLOGY GROUP PC
Entity type:Organization
Organization Name:DERMATOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:DUNAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-761-0685
Mailing Address - Street 1:5210 POPLAR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3515
Mailing Address - Country:US
Mailing Address - Phone:901-761-0685
Mailing Address - Fax:901-761-0688
Practice Address - Street 1:5210 POPLAR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3515
Practice Address - Country:US
Practice Address - Phone:901-761-0685
Practice Address - Fax:901-761-0688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5706207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3380998Medicare ID - Type Unspecified