Provider Demographics
NPI:1376830562
Name:BUNCH, JENNIFER RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RAY
Last Name:BUNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8839 BRYAN DAIRY RD STE 235
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1207
Mailing Address - Country:US
Mailing Address - Phone:727-495-6085
Mailing Address - Fax:727-873-6325
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 235
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1207
Practice Address - Country:US
Practice Address - Phone:727-495-6085
Practice Address - Fax:727-873-6325
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127245207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18215100Medicaid