Healthcare Provider Details

I. General information

NPI: 1295773125
Provider Name (Legal Business Name): LAURA CHRISTOPHER BUNCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MONTEVALLO RD SUITE E101
IRONDALE AL
35210-3129
US

IV. Provider business mailing address

PO BOX 742360
ATLANTA GA
30374-2103
US

V. Phone/Fax

Practice location:
  • Phone: 205-490-4690
  • Fax: 205-777-4888
Mailing address:
  • Phone: 205-940-4690
  • Fax: 205-777-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number22389
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: