MEDICARE: DR. EDWARD EARL BUNCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	H3658	TX

General Provider Information

NPI Number	:	1285702563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD EARL BUNCH M.D.

Provider Business Mailing Address
First Line	:	415 E FM 2410 RD
Second Line	:	UNIT 2818
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2934
Country	:	US
Telephone Number	:	254-690-2338
Fax Number	:	254-690-2349

Provider Business Practice Location Address
First Line	:	415 E FM 2410 RD
Second Line	:	UNIT 2818
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-2934
Country	:	US
Telephone Number	:	254-690-2338
Fax Number	:	254-690-2349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	05/14/2019

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