Provider Demographics
NPI:1821027210
Name:BUNDY, JOHN MCCALL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MCCALL
Last Name:BUNDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:MCCALL
Other - Last Name:BUNDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:520 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6737
Mailing Address - Country:US
Mailing Address - Phone:405-936-5910
Mailing Address - Fax:405-577-2605
Practice Address - Street 1:520 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099
Practice Address - Country:US
Practice Address - Phone:405-936-5910
Practice Address - Fax:405-577-2605
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK13740OtherLICENSE
OK080047862OtherRAILROAD
OK14847OtherOBNDD
OK100152580AMedicaid
D34460Medicare UPIN
OK13740OtherLICENSE