Provider Demographics
NPI:1487633186
Name:BUNCHMAN, HERBERT H II (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:H
Last Name:BUNCHMAN
Suffix:II
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 1:1520 S DOBSON RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4725
Mailing Address - Country:US
Mailing Address - Phone:480-833-5200
Mailing Address - Fax:480-833-2967
Practice Address - Street 1:1520 S DOBSON RD
Practice Address - Street 2:SUITE 314
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4725
Practice Address - Country:US
Practice Address - Phone:480-833-5200
Practice Address - Fax:480-833-2967
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8713174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99219Medicare UPIN