Provider Demographics
NPI:1831191014
Name:DUNBARR, JEREMY D (PA)
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:D
Last Name:DUNBARR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3915 WATSON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1251
Mailing Address - Country:US
Mailing Address - Phone:314-244-3818
Mailing Address - Fax:888-464-1108
Practice Address - Street 1:3915 WATSON RD STE 202
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-244-3818
Practice Address - Fax:888-464-1106
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005004535363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35834Medicare UPIN
MOJ35D639Medicare ID - Type Unspecified
KS139D639Medicare ID - Type Unspecified