Provider Demographics
NPI:1255414454
Name:DAVID W. BUNTLEY, M. D., INC
Entity type:Organization
Organization Name:DAVID W. BUNTLEY, M. D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BUNTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-252-2810
Mailing Address - Street 1:2601 W ELK AVE
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1572
Mailing Address - Country:US
Mailing Address - Phone:580-252-2810
Mailing Address - Fax:580-252-3031
Practice Address - Street 1:2601 W ELK AVE
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1572
Practice Address - Country:US
Practice Address - Phone:580-252-2810
Practice Address - Fax:580-252-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9887208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100094430BMedicaid
OKC94735Medicare UPIN