Provider Demographics
NPI:1225305170
Name:BUNKER, CODY KIRT
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:KIRT
Last Name:BUNKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 E 650 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3950
Mailing Address - Country:US
Mailing Address - Phone:435-229-0369
Mailing Address - Fax:
Practice Address - Street 1:176 E 650 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3950
Practice Address - Country:US
Practice Address - Phone:435-229-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker