Provider Demographics
NPI:1730174442
Name:BUNCH, GARY M (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:BUNCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 3RD AVE W
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8626
Mailing Address - Country:US
Mailing Address - Phone:941-744-2700
Mailing Address - Fax:941-744-2705
Practice Address - Street 1:200 3RD AVE W
Practice Address - Street 2:SUITE 110
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8626
Practice Address - Country:US
Practice Address - Phone:941-744-2700
Practice Address - Fax:941-744-2705
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2012-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME80522208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL464509OtherAMERIHEALTH
FL00025244502OtherUNIVERA
FL204514OtherSTAYWELL HEALTHEASE WELLC
FL4326801OtherAETNA
FL0198407OtherGHI
FL030480068003OtherMEDICAL MUTUAL
FL265425300Medicaid
FL020052908OtherRAIL ROAD MEDICARE
FL35598OtherBCBS
FL2545711OtherCIGNA
FL706517OtherUPMC
FL802483OtherHARVARD PILGRIM HPHC
FL90192OtherHEALTHPARTNERS
FL020052908OtherRAIL ROAD MEDICARE
FL265425300Medicaid