Basic Information
| Provider Information | |||||||||
| NPI: | 1417046160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNBAR | ||||||||
| FirstName: | LEVETTE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15260 NW 147TH DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | ALACHUA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326155339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522739120 | ||||||||
| FaxNumber: | 3523928725 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 S JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | PERRY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323485611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8555775437 | ||||||||
| FaxNumber: | 8508382140 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | ME91334 | FL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | 208000000X | ME91334 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 278596000 | 05 | FL | MEDICAID |