Healthcare Provider Details

I. General information

NPI: 1376712257
Provider Name (Legal Business Name): DOUGLAS BUNGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

PO BOX 1522
PORT ORCHARD WA
98366-0130
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN00092020
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: