Provider Demographics
NPI:1700864188
Name:BUNN, DAVID GLENN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GLENN
Last Name:BUNN
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 1:5919 OLEANDER DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4757
Mailing Address - Country:US
Mailing Address - Phone:910-798-5544
Mailing Address - Fax:910-798-5566
Practice Address - Street 1:5919 OLEANDER DR
Practice Address - Street 2:SUITE 109
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4757
Practice Address - Country:US
Practice Address - Phone:910-798-5544
Practice Address - Fax:910-798-5566
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20771174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCAB7073315OtherDEA NUMBER
NC205133EMedicare ID - Type Unspecified
NCAB7073315OtherDEA NUMBER