Healthcare Provider Details

I. General information

NPI: 1275815888
Provider Name (Legal Business Name): DAMIAN BUNDSCHUH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9590 E IRONWOOD SQUARE DR SUITE 106
SCOTTSDALE AZ
85258-4581
US

IV. Provider business mailing address

9590 E IRONWOOD SQUARE DR SUITE 106
SCOTTSDALE AZ
85258-4581
US

V. Phone/Fax

Practice location:
  • Phone: 480-391-7631
  • Fax: 480-314-5493
Mailing address:
  • Phone: 480-391-7631
  • Fax: 480-314-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number005955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: