Provider Demographics
NPI:1639616931
Name:BUNNING, LANCE (LMT)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:
Last Name:BUNNING
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17422 108TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5400
Mailing Address - Country:US
Mailing Address - Phone:425-255-0427
Mailing Address - Fax:425-255-1066
Practice Address - Street 1:17422 108TH AVE SE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5400
Practice Address - Country:US
Practice Address - Phone:425-255-0427
Practice Address - Fax:425-255-1066
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005302208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation