Provider Demographics
NPI:1548468036
Name:DUNN, CLIFFORD VERNOR III (MD)
Entity type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:VERNOR
Last Name:DUNN
Suffix:III
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 1:851 MARSHALL PHELPS RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2100
Mailing Address - Country:US
Mailing Address - Phone:860-683-0756
Mailing Address - Fax:860-683-1555
Practice Address - Street 1:851 MARSHALL PHELPS RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095
Practice Address - Country:US
Practice Address - Phone:860-683-0756
Practice Address - Fax:860-683-1555
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6626822-1205207Q00000X
CT62665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063224Medicare PIN