Healthcare Provider Details

I. General information

NPI: 1255457693
Provider Name (Legal Business Name): JEFFREY W BUNCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 SAM RITTENBERG BLVD STE 1
CHARLESTON SC
29407-3362
US

IV. Provider business mailing address

1124 SAM RITTENBERG BLVD STE 1
CHARLESTON SC
29407-3362
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-3462
  • Fax: 843-766-2103
Mailing address:
  • Phone: 843-556-3462
  • Fax: 843-766-2103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15523
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: