Provider Demographics
NPI:1427014117
Name:BUNKER, STEPHEN RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RAYMOND
Last Name:BUNKER
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 1:2712 BEE CAVES RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5676
Mailing Address - Country:US
Mailing Address - Phone:512-726-0599
Mailing Address - Fax:800-308-9876
Practice Address - Street 1:2712 BEE CAVES RD
Practice Address - Street 2:SUITE #122
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5676
Practice Address - Country:US
Practice Address - Phone:512-726-0599
Practice Address - Fax:800-308-9876
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG366472085R0202X, 2085N0904X
TXG09612085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G366471Medicaid
F01280Medicare UPIN
CA00G366470Medicare PIN
TXTXB146203Medicare PIN