Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 311388 | LA |
NPI | 1205061504 |
---|---|
Provider Name | Kevin Jeffrey Bunn |
First Address | Monroe, LA 71201-7363 |
Second Address | Monroe, LA 71201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2009 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2487612 | (05) | LA |