Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 0044414 | FL |
NPI | 1124213467 |
---|---|
Provider Name | Dr. Ralph Lawson Bundy |
First Address | Ormond Beach, FL 32176-2353 |
Second Address | Ormond Beach, FL 32176-2353 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2007 |
Last Update Date | 29/11/2016 |