Basic Information
| Provider Information | |||||||||
| NPI: | 1073735270 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNN | ||||||||
| FirstName: | INGRID | ||||||||
| MiddleName: | PATRICIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3701 AVALON PARK WEST BLVD | ||||||||
| Address2: | SUITE #230 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328287303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074532072 | ||||||||
| FaxNumber: | 4076011053 | ||||||||
| Practice Location | |||||||||
| Address1: | 3701 AVALON PARK WEST BLVD | ||||||||
| Address2: | SUITE #230 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328287303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074532072 | ||||||||
| FaxNumber: | 4076011053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 03/13/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME 104799 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | CX948Y | 01 | FL | MEDICARE PTAN | OTHER | CX949A | 01 | FL | MEDICARE PTAN | OTHER | 001933000 | 05 | FL | MEDICAID | 002284400 | 05 | FL | MEDICAID |