Provider Demographics
NPI:1043478456
Name:BUNTIN, GERALD STEWART (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:STEWART
Last Name:BUNTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 GLATT ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-5608
Mailing Address - Country:US
Mailing Address - Phone:864-387-9741
Mailing Address - Fax:
Practice Address - Street 1:1917 GLATT ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-5608
Practice Address - Country:US
Practice Address - Phone:864-387-9741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30806208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist