Provider Demographics
NPI:1861546301
Name:BUNTMAN, KAREN R (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:R
Last Name:BUNTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 E 18TH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4081
Mailing Address - Country:US
Mailing Address - Phone:541-343-8555
Mailing Address - Fax:541-343-8555
Practice Address - Street 1:74 E 18TH
Practice Address - Street 2:SUITE 1
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4081
Practice Address - Country:US
Practice Address - Phone:541-343-8555
Practice Address - Fax:541-343-8555
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR269118Medicaid
A046501OtherPACIFIC SOURCE
OR269118Medicaid
A046501OtherPACIFIC SOURCE