Individual
JACK D DUNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2130 MESQUITE AVE UNIT 108, LAKE HAVASU CITY, AZ 86403-6897
(928) 854-9433
(928) 854-9443
Mailing address
2130 MESQUITE AVE UNIT 108, LAKE HAVASU CITY, AZ 86403-6897
(928) 854-9433
(928) 854-9443
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
22884
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218067
—
AZ
01
—
300113271
RAILROAD MEDICARE
AZ
Enumeration date
09/13/2005
Last updated
07/21/2022
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