1487649869 NPI number — DR. JAMES DEAN BUNKER M.D.

Table of content: (NPI 1396535621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487649869 NPI number — DR. JAMES DEAN BUNKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNKER
Provider First Name:
JAMES
Provider Middle Name:
DEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1487649869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 S WILLOW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PLATTE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69101-5279
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-534-1700
Provider Business Mailing Address Fax Number:
308-534-8689

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 S WILLOW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-5279
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-534-1700
Provider Business Practice Location Address Fax Number:
308-534-8689
Provider Enumeration Date:
09/13/2005

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: 207N00000X , with the licence number:  20039 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 070008889 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 20039 . This is a "NE MEDICAL LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 31026 . This is a "BC/BS PROVIDER NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 470797269 . This is a "UPREHS PROVIDER NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 47079726900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004736 . This is a "AAD ID NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 28D0913222 . This is a "CLIA CERTIFICATION NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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