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General NPI Number Information
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NPI Number | 1023750684
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Entity Type | Organization
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Legal Business Name | ELLEN F BUNCH MD PLLC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 1456 W GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-2828
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Country | US
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Telephone | 928-777-8880
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Fax | 928-777-8884
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Provider Business Mailing Address
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Address Line | 1456 W GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-2828
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Country | US
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Telephone | 928-777-8880
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Fax | 928-777-8884
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MR. KENNETH L BUNCH
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Credential |
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Telephone | 928-777-8880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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