Provider Demographics
NPI:1871612424
Name:DUNN, W THOMAS JR (MD)
Entity type:Individual
Prefix:DR
First Name:W
Middle Name:THOMAS
Last Name:DUNN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24 N AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8710
Mailing Address - Country:US
Mailing Address - Phone:207-777-4624
Mailing Address - Fax:207-782-9652
Practice Address - Street 1:24 N AUBURN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8710
Practice Address - Country:US
Practice Address - Phone:207-777-4624
Practice Address - Fax:207-782-9652
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013163207LP2900X
MA58117207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3114741Medicaid
MA3114741Medicaid