Provider Demographics
NPI:1487649869
Name:BUNKER, JAMES DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEAN
Last Name:BUNKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5279
Mailing Address - Country:US
Mailing Address - Phone:308-534-1700
Mailing Address - Fax:308-534-8689
Practice Address - Street 1:825 S WILLOW ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5279
Practice Address - Country:US
Practice Address - Phone:308-534-1700
Practice Address - Fax:308-534-8689
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20039207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE070008889OtherRAILROAD MEDICARE NUMBER
NE20039OtherNE MEDICAL LICENSE
NE31026OtherBC/BS PROVIDER NUMBER
NE470797269OtherUPREHS PROVIDER NUMBER
NE47079726900Medicaid
NE004736OtherAAD ID NUMBER
NE28D0913222OtherCLIA CERTIFICATION NUMBER