1730174442 NPI number — GARY M BUNCH MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730174442 NPI number — GARY M BUNCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNCH
Provider First Name:
GARY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730174442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 3RD AVE W
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34205-8626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-744-2700
Provider Business Mailing Address Fax Number:
941-744-2705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 3RD AVE W
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34205-8626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-744-2700
Provider Business Practice Location Address Fax Number:
941-744-2705
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  ME80522 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 464509 . This is a "AMERIHEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00025244502 . This is a "UNIVERA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 204514 . This is a "STAYWELL HEALTHEASE WELLC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4326801 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0198407 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 030480068003 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 265425300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020052908 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 35598 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2545711 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 706517 . This is a "UPMC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 802483 . This is a "HARVARD PILGRIM HPHC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 90192 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com