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

Table of content: DR. JAMES DEAN BUNKER M.D. (NPI 1487649869)

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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