Provider Demographics
NPI:1003471376
Name:BUNCY, ADAM TIMOTHY (PHYSICIAN ASSITANT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TIMOTHY
Last Name:BUNCY
Suffix:
Gender:M
Credentials:PHYSICIAN ASSITANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE BAYBERRY CT
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-6820
Mailing Address - Country:US
Mailing Address - Phone:772-341-8217
Mailing Address - Fax:
Practice Address - Street 1:1001 SE MONTEREY COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3329
Practice Address - Country:US
Practice Address - Phone:772-286-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program