Provider Demographics
NPI:1730307943
Name:BUNCH, ROBERT BRADLEY (RN RNFA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:BUNCH
Suffix:
Gender:M
Credentials:RN RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1000 EAST 7TH PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:SHATTUCK
Mailing Address - State:OK
Mailing Address - Zip Code:73858
Mailing Address - Country:US
Mailing Address - Phone:580-938-5032
Mailing Address - Fax:580-938-2615
Practice Address - Street 1:905 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:SHATTUCK
Practice Address - State:OK
Practice Address - Zip Code:73858
Practice Address - Country:US
Practice Address - Phone:580-938-2551
Practice Address - Fax:580-938-2615
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO53415163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant