Healthcare Provider Details

I. General information

NPI: 1649244096
Provider Name (Legal Business Name): PAUL BUNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 BURNLEY RD
SCOTTSVILLE KY
42164-6355
US

IV. Provider business mailing address

401 BRICE AVE
GLASGOW KY
42141-2207
US

V. Phone/Fax

Practice location:
  • Phone: 270-622-2800
  • Fax:
Mailing address:
  • Phone: 270-651-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37124
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: