Provider Demographics
NPI:1942494927
Name:ANTONIO BUNKER-HUERTAS MD PL
Entity type:Organization
Organization Name:ANTONIO BUNKER-HUERTAS MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:BUNKER-HUERTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-932-2848
Mailing Address - Street 1:7001 N DALE MABRY HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3910
Mailing Address - Country:US
Mailing Address - Phone:813-932-2848
Mailing Address - Fax:813-932-7551
Practice Address - Street 1:7001 N DALE MABRY HWY
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3910
Practice Address - Country:US
Practice Address - Phone:813-932-2848
Practice Address - Fax:813-932-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92962207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI42156Medicare UPIN