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General NPI Number Information
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NPI Number | 1487004230
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Entity Type | Individual
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Provider Name | GLEN JASON BUNN JR. MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1 MEADOWS PKWY
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City | VIDALIA
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State | GA
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Zip | 30474-8759
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Country | US
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Telephone | 912-535-5555
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Fax | 912-535-5891
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Provider Business Mailing Address
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Address Line | 1000 HOUGHTON AVE
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City | SAGINAW
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State | MI
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Zip | 48602-5303
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Country | US
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Telephone | 989-583-6800
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301110110
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 82620
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 82620
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License Number State | GA
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