Basic Information
| Provider Information | |||||||||
| NPI: | 1598764003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NUNLEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1680 S CENTRAL BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617481116 | ||||||||
| FaxNumber: | 5617482997 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 S CENTRAL BLVD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | JUPITER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334587395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617481116 | ||||||||
| FaxNumber: | 5617482997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 02/22/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/18/2006 | ||||||||
| NPIReactivationDate: | 04/05/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME90263 | FL | Y | Other Service Providers | Specialist |
No ID Information.