Provider Demographics
NPI:1295863520
Name:BUNCKE, GEOFFREY HARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:HARRY
Last Name:BUNCKE
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 1:1040 NW 22ND #550
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-973-5000
Mailing Address - Fax:503-274-0188
Practice Address - Street 1:1040 NW 22ND AVE
Practice Address - Street 2:SUITE 550
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-973-5000
Practice Address - Fax:503-274-0188
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR238062082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR23806OtherSTATE LICENSE
OR23806OtherSTATE LICENSE