1346217031 NPI number — MR. GLENN DUNLAP DPM

Table of content: MR. GLENN DUNLAP DPM (NPI 1346217031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346217031 NPI number — MR. GLENN DUNLAP DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNLAP
Provider First Name:
GLENN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346217031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4839
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PINEHURST
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28374-4839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-751-9120
Provider Business Mailing Address Fax Number:
919-751-9170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 REGIONAL DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374-8850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-751-9120
Provider Business Practice Location Address Fax Number:
919-751-9170
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  286 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 286 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08062 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890805K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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