Provider Demographics
NPI:1598081945
Name:PATRICK BUNYI MD LLC
Entity Type:Organization
Organization Name:PATRICK BUNYI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:PANAJON
Authorized Official - Last Name:BUNYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-374-3311
Mailing Address - Street 1:819 TOWNSEND BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-6132
Mailing Address - Country:US
Mailing Address - Phone:904-374-3311
Mailing Address - Fax:
Practice Address - Street 1:819 TOWNSEND BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-6132
Practice Address - Country:US
Practice Address - Phone:904-374-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-09
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68800261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1871518787OtherNPI FOR PATRICK BUNYI, MD
FLG 12036Medicare UPIN