Provider Demographics
NPI:1780105817
Name:BUNYASARANAND, JOHN CHRISTEN (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTEN
Last Name:BUNYASARANAND
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 1:4315 EL SALVADOR WAY
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1711
Mailing Address - Country:US
Mailing Address - Phone:850-885-2371
Mailing Address - Fax:
Practice Address - Street 1:4315 EL SALVADOR WAY
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1711
Practice Address - Country:US
Practice Address - Phone:850-885-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2634171000000X
ALDO.2634207P00000X
390200000X
FLOS18810207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000OtherMEDICARE UPIN