Healthcare Provider Details

I. General information

NPI: 1003471376
Provider Name (Legal Business Name): ADAM TIMOTHY BUNCY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SE MONTEREY COMMONS BLVD
STUART FL
34996-3329
US

IV. Provider business mailing address

3 QUAIL RUN LN
STUART FL
34996-6602
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-9400
  • Fax:
Mailing address:
  • Phone: 772-341-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: