Provider Demographics
NPI:1972747517
Name:DUNAWAY, MICHAEL TRAYSER
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TRAYSER
Last Name:DUNAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:M.
Other - Middle Name:TRAY
Other - Last Name:DUNAWAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1413 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2934
Mailing Address - Country:US
Mailing Address - Phone:803-425-8555
Mailing Address - Fax:
Practice Address - Street 1:1413 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2934
Practice Address - Country:US
Practice Address - Phone:803-425-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12735208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC60068Medicare UPIN