Provider Demographics
NPI:1407840440
Name:BUNTING, DOUGLAS L (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:BUNTING
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:PO BOX 11037
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32524-1037
Mailing Address - Country:US
Mailing Address - Phone:850-444-7000
Mailing Address - Fax:850-444-7497
Practice Address - Street 1:1619 CREIGHTON RD STE 1
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7152
Practice Address - Country:US
Practice Address - Phone:850-444-4700
Practice Address - Fax:850-444-7497
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500850207RN0300X
ALMD.31814207RN0300X
FLME114135207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008261000Medicaid
ALP01181590OtherALABAMA RAILROAD MEDICARE
NC9500850OtherN. CAROLINA MEDICAL LICENSE
ALMD.31814OtherALABAMA MEDICAL LICENSE
FLME114135OtherFLORIDA MEDICAL LICENSE
FLP01183151OtherFLORIDA RAILROAD MEDICARE
ALMD.31814OtherALABAMA MEDICAL LICENSE
FLP01183151OtherFLORIDA RAILROAD MEDICARE