Basic Information
| Provider Information | |||||||||
| NPI: | 1952583213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVID C NUNLEY RADIOLOGY INC | ||||||||
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| 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: | 11/28/2007 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| AuthorizedOfficialLastName: | NUNLEY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | CHARLES | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5617481116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME90263 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 272766800 | 05 | FL | MEDICAID |