Individual
GARY L DUNNINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
545 BARNHILL DR, EH 203, INDIANAPOLIS, IN 46202-5112
(317) 274-0283
(317) 278-1635
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01071798A
IN
2086X0206X
Surgical Oncology Physician
036096459
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000791600
ANTHEM PIN
IN
05
—
036096459
—
IL
05
—
201114420
—
IN
Enumeration date
11/11/2005
Last updated
06/19/2014
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