Healthcare Provider Details

I. General information

NPI: 1922006147
Provider Name (Legal Business Name): BRAD R BUNDY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W WALLACE ST SUITE A-1
FINDLAY OH
45840-1242
US

IV. Provider business mailing address

1211 S MAIN ST
FINDLAY OH
45840-2240
US

V. Phone/Fax

Practice location:
  • Phone: 419-423-2996
  • Fax: 419-423-1379
Mailing address:
  • Phone: 419-423-2996
  • Fax: 419-423-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34-004421
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: