Organization
LAKE HAVASU RADIOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK D DUNN MD (MANAGING MEMBER)
(928) 453-0802
Entity
Organization
Contact information
Practice address
101 CIVIC CENTER LN, LAKE HAVASU CITY, AZ 86403-5607
(928) 453-6236
(928) 453-7809
Mailing address
PO BOX 1766, LAKE CHARLES, LA 70602-1766
(337) 721-1961
(337) 721-1939
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
08/09/2007
Last updated
05/09/2008
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