Basic Information
Provider Information
NPI: 1003009853
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUNN
FirstName: GRACE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 23343 NW COUNTY ROAD 236
Address2:  
City: HIGH SPRINGS
State: FL
PostalCode: 326439669
CountryCode: US
TelephoneNumber: 3524632374
FaxNumber: 3524632726
Practice Location
Address1: 1830 N MAIN ST
Address2:  
City: BELL
State: FL
PostalCode: 326194713
CountryCode: US
TelephoneNumber: 3524632374
FaxNumber: 3524634507
Other Information
ProviderEnumerationDate: 08/24/2007
LastUpdateDate: 01/15/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/15/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XME104728FLY Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
ED473Z01FLMEDICARE PTANOTHER
00256370005FL MEDICAID


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