Provider Demographics
NPI:1174516207
Name:WARNERDUNLOP, MARY GRACE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GRACE
Last Name:WARNERDUNLOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:DUNLOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7350 E STETSON DR
Mailing Address - Street 2:STE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3432
Mailing Address - Country:US
Mailing Address - Phone:480-941-0800
Mailing Address - Fax:480-941-8333
Practice Address - Street 1:7350 E STETSON DR
Practice Address - Street 2:STE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3432
Practice Address - Country:US
Practice Address - Phone:480-941-0800
Practice Address - Fax:480-941-8333
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13927207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0860530OtherAZBCBS
AZ238586Medicaid
E36946Medicare UPIN
AZ238586Medicaid