Healthcare Provider Details

I. General information

NPI: 1609034420
Provider Name (Legal Business Name): DONNIE W BUNCH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 SAINT JOSEPH LN
LONDON KY
40741-8345
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 606-330-2377
  • Fax: 606-330-2369
Mailing address:
  • Phone: 606-330-7840
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03235
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: