Provider Demographics
NPI:1669253399
Name:BUNYARD, JESS (CRM)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:
Last Name:BUNYARD
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 NE SANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2884
Mailing Address - Country:US
Mailing Address - Phone:503-506-0246
Mailing Address - Fax:
Practice Address - Street 1:1805 NE SANDY BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2884
Practice Address - Country:US
Practice Address - Phone:503-506-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist