Provider Demographics
NPI:1215929278
Name:BUNTING, DARRIN R (DO)
Entity type:Individual
Prefix:
First Name:DARRIN
Middle Name:R
Last Name:BUNTING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3546
Mailing Address - Country:US
Mailing Address - Phone:419-627-9933
Mailing Address - Fax:419-627-8175
Practice Address - Street 1:1725 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-3546
Practice Address - Country:US
Practice Address - Phone:419-627-9933
Practice Address - Fax:419-627-8175
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6641-B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2028719Medicaid
OH2028719Medicaid
OHDA0827181Medicare ID - Type Unspecified