Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G863450 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | G863450 | CA |
NPI | 1154369460 |
---|---|
Provider Name | Frank Laurence Bunch JR. |
First Address | Coldwater, MI 49036-9462 |
Second Address | Coldwater, MI 49036-9462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 27/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G863450 | (05) | CA |
36-4354262 | GROUP TAX ID (01) | |
B73848 | (02) | CA |
FB093345 | MI STATE LICENSE (01) | MI |
GR0094720 | (05) | CA |
ZZZ92551Z | MEDICARE GROUP NUMBER (01) | CA |