MEDICARE: DR. LAURA CHRISTOPHER BUNCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RX0202X	Medical Oncology Physician	22389	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51131239	OTHER	AL	BCBSAL

General Provider Information

NPI Number	:	1295773125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA CHRISTOPHER BUNCH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 742360
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2103
Country	:	US
Telephone Number	:	205-940-4690
Fax Number	:	205-777-4888

Provider Business Practice Location Address
First Line	:	4500 MONTEVALLO RD
Second Line	:	SUITE E101
City	:	IRONDALE
State	:	AL
Zip	:	35210-3129
Country	:	US
Telephone Number	:	205-490-4690
Fax Number	:	205-777-4888

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	06/20/2013

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