Basic Information
| Provider Information | |||||||||
| NPI: | 1306026505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUNHAM | ||||||||
| FirstName: | MIRIAM | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 PINOLE VALLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | PINOLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107521000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1301 PINOLE VALLEY ROAD | ||||||||
| Address2: | |||||||||
| City: | PINOLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107521000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2007 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A97051 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.