Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 117535-2501 | UT |
Y | 103T00000X | Psychologist | 117535-2501 | UT |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 117535-2501 | UT |
N | 103TH0100X | Health Service | 117535-2501 | UT |
NPI | 1194789297 |
---|---|
Provider Name | Dr. Douglas B Bunker |
First Address | Salt Lake City, UT 84105-1548 |
Second Address | Salt Lake City, UT 84105-1548 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 26/04/2011 |