Provider Demographics
NPI:1437139037
Name:DUNN, JACK H (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:H
Last Name:DUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 37020
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-7020
Mailing Address - Country:US
Mailing Address - Phone:520-299-9660
Mailing Address - Fax:520-529-3629
Practice Address - Street 1:1501 N. CAMPBELL AVENUE
Practice Address - Street 2:DEPARTMENT OF SURGERY ROOM 4310
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5066
Practice Address - Country:US
Practice Address - Phone:520-250-1140
Practice Address - Fax:520-529-3629
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11946207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ201313Medicaid
AZ201313Medicaid
AZD36783Medicare UPIN