Individual
MR. COLIN MICHAEL DUNDERDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 539-9582
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 539-9582
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1057638
—
363A00000X
Physician Assistant
Primary
PA09795
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350463101
—
TX
01
—
350463102
CSHCN
TX
Enumeration date
10/03/2006
Last updated
01/17/2023
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