Provider Demographics
NPI:1376619072
Name:BUNT, RICHARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:BUNT
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 1:4031 DIXIE HWY NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3682
Mailing Address - Country:US
Mailing Address - Phone:321-622-3222
Mailing Address - Fax:321-622-3203
Practice Address - Street 1:4031 DIXIE HWY NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3682
Practice Address - Country:US
Practice Address - Phone:321-622-3222
Practice Address - Fax:321-622-3203
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAME0468342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00815746CMedicaid
FL278284700Medicaid
GA00815746CMedicaid
FLAE276ZMedicare PIN
GA26BDGXSMedicare PIN