Basic Information
| Provider Information | |||||||||
| NPI: | 1346320330 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNBAR | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 501123 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631500001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152848740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 20TH AVE N STE 106 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152845887 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 12/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD13640 | TN | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | MD0000013640 | TN | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1507971 | 05 | TN | MEDICAID | 4082752 | 01 | AETNA | OTHER | 3741577 | 01 | CIGNA | OTHER | 4189042 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | A97250 | 01 | TN | HEALTHSPRING | OTHER |