Provider Demographics
NPI:1275815888
Name:BUNDSCHUH, DAMIAN (DO)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:
Last Name:BUNDSCHUH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9590 E IRONWOOD SQUARE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4581
Mailing Address - Country:US
Mailing Address - Phone:480-391-7631
Mailing Address - Fax:480-314-5493
Practice Address - Street 1:9590 E IRONWOOD SQUARE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4581
Practice Address - Country:US
Practice Address - Phone:480-391-7631
Practice Address - Fax:480-314-5493
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005955204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ92176Medicare PIN