Provider Demographics
NPI:1902982473
Name:BUNN, WILEY DOUGLAS JR (MD)
Entity Type:Individual
Prefix:MR
First Name:WILEY
Middle Name:DOUGLAS
Last Name:BUNN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:475 IRVING AVENUE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-634-4112
Mailing Address - Fax:315-634-4117
Practice Address - Street 1:475 IRVING AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-634-4112
Practice Address - Fax:315-634-4117
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-01-17
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Provider Licenses
StateLicense IDTaxonomies
NY200121207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF35698Medicare UPIN
NYDD2654Medicare PIN
NY980000433Medicare PIN