Provider Demographics
NPI:1285626986
Name:BUNN, WILLIAM BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRUCE
Last Name:BUNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:206 CORNELIA ST
Mailing Address - Street 2:STE 307
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2779
Mailing Address - Country:US
Mailing Address - Phone:518-562-7705
Mailing Address - Fax:518-562-7706
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:STE 307
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2779
Practice Address - Country:US
Practice Address - Phone:518-562-7705
Practice Address - Fax:518-562-7706
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196475207RC0200X, 207RP1001X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01498897Medicaid
F30136Medicare UPIN
51601DMedicare ID - Type Unspecified