Provider Demographics
NPI:1922006147
Name:BUNDY, BRAD R (DO)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:R
Last Name:BUNDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1211 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-2240
Mailing Address - Country:US
Mailing Address - Phone:419-423-2996
Mailing Address - Fax:419-423-1379
Practice Address - Street 1:300 W WALLACE ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1242
Practice Address - Country:US
Practice Address - Phone:419-423-2996
Practice Address - Fax:419-423-1379
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0044212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE59748Medicare UPIN