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General NPI Number Information
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NPI Number | 1407004872
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Entity Type | Individual
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Provider Name | PAMELA WILBANKS BUNTING DO
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Gender | Female
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 11/12/2020
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Provider Practice Location Address
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Address Line | 1011 BOWLES AVE STE G10
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City | FENTON
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State | MO
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Zip | 63026-2387
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Country | US
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Telephone | 636-496-5453
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 955534
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City | SAINT LOUIS
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State | MO
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Zip | 63195-5534
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 2009007650
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2009007650
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License Number State | MO
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