Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1098 | OR |
N | 103T00000X | Psychologist | 1098 | OR |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 1098 | OR |
N | 103TA0700X | Adult Development & Aging Psychologist | 1098 | OR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1098 | OR |
N | 103G00000X | Clinical Psychologist | 1098 | OR |
N | 103TC0700X | Clinical Psychologist | 1098 | OR |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 1098 | OR |
N | 103TF0000X | Family Psychologist | 1098 | OR |
N | 103TH0100X | Health Service | 1098 | OR |
N | 103TP2701X | Group Psychotherapist | 1098 | OR |
N | 103TR0400X | Rehabilitation Psychologist | 1098 | OR |
NPI | 1669537486 |
---|---|
Provider Name | Dr. John Bundy |
First Address | Eugene, OR 97401-4159 |
Second Address | Eugene, OR 97401-4159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R01193 | (02) | OR |