Healthcare Provider Details

I. General information

NPI: 1598728925
Provider Name (Legal Business Name): ROSS EDWARD BUNCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 COMMONS NORTH DR SUITE A
TUSCALOOSA AL
35406-3700
US

IV. Provider business mailing address

1847 COMMONS NORTH DR SUITE A
TUSCALOOSA AL
35406-3700
US

V. Phone/Fax

Practice location:
  • Phone: 205-349-0049
  • Fax: 205-345-1684
Mailing address:
  • Phone: 205-349-0049
  • Fax: 205-345-1684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number19040
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: