Healthcare Provider Details

I. General information

NPI: 1619552866
Provider Name (Legal Business Name): TROY MATTHEW BUNCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 HICKMAN RD
DES MOINES IA
50314-1597
US

IV. Provider business mailing address

450 LAUREL ST
DES MOINES IA
50314-3045
US

V. Phone/Fax

Practice location:
  • Phone: 515-282-8844
  • Fax:
Mailing address:
  • Phone: 515-247-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number115981
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number115981
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: