Provider Demographics
NPI:1144497009
Name:DUNLAP, GERALD ACHESON (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:ACHESON
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1510 DIVISION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1581
Practice Address - Country:US
Practice Address - Phone:503-650-6880
Practice Address - Fax:503-650-6888
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLL17373207R00000X
ORMD151063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00940164OtherRR MEDICARE
OR500623081Medicaid
ORP00940164OtherRR MEDICARE
OR500623081Medicaid
ORR155096Medicare PIN
ORR159640Medicare PIN