Provider Demographics
NPI:1205820099
Name:BUNKER, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:BUNKER
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 1:4376 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6867
Mailing Address - Country:US
Mailing Address - Phone:309-762-0777
Mailing Address - Fax:309-762-0077
Practice Address - Street 1:4376 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6867
Practice Address - Country:US
Practice Address - Phone:309-762-0777
Practice Address - Fax:309-762-0077
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087189208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336049157OtherCONTROLLED SUBSTANCE#
IL8122859OtherILLINOIS BC/BS
IA421060724OtherBILLING TAX ID# FOR CHC
IL93613OtherIOWA BC/BS SEEN IN MOLINE
ILIL01A4OtherJOHN DEERE EDI#
IL094112OtherHEALTH ALLIANCE
IL421060724A4OtherJOHN DEERE HEALTH
IA0568980Medicaid
IA0568998Medicaid
IL421060724003Medicaid
IL036087189Medicaid
IL036087189Medicaid
BB5899793OtherFEDERAL DEA#
ILIL01A4OtherJOHN DEERE EDI#
IL93613OtherIOWA BC/BS SEEN IN MOLINE