Provider Demographics
NPI:1093862120
Name:BUNAS, STANLEY JON (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JON
Last Name:BUNAS
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 1:108 2ND AVE S APT 306
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6584
Mailing Address - Country:US
Mailing Address - Phone:425-891-0262
Mailing Address - Fax:425-688-8850
Practice Address - Street 1:1515 116TH AVE NE STE 307
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3811
Practice Address - Country:US
Practice Address - Phone:425-688-8860
Practice Address - Fax:425-688-8850
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020566174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528504Medicaid
WA1528504Medicaid