Provider Demographics
NPI:1831318534
Name:BUNN, THOMAS (AUD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BUNN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E LAKE HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-3155
Mailing Address - Country:US
Mailing Address - Phone:863-299-1251
Mailing Address - Fax:863-299-7666
Practice Address - Street 1:160 E LAKE HOWARD DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-3155
Practice Address - Country:US
Practice Address - Phone:863-299-1251
Practice Address - Fax:863-299-7666
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY111231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS0816Medicare ID - Type Unspecified