Provider Demographics
NPI:1730289380
Name:BUNCH, ELLEN F (MD, FIM, BSE, BAA)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:F
Last Name:BUNCH
Suffix:
Gender:F
Credentials:MD, FIM, BSE, BAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1456 W GURLEY ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-2828
Mailing Address - Country:US
Mailing Address - Phone:928-777-8880
Mailing Address - Fax:928-777-8884
Practice Address - Street 1:1456 W GURLEY ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-2828
Practice Address - Country:US
Practice Address - Phone:928-777-8880
Practice Address - Fax:928-777-8884
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI06962Medicare UPIN