Provider Demographics
NPI:1871595892
Name:BUNKER, SUZANNE RENEE (PA -C)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:RENEE
Last Name:BUNKER
Suffix:
Gender:F
Credentials:PA -C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FRIONA
Mailing Address - State:TX
Mailing Address - Zip Code:79035-1504
Mailing Address - Country:US
Mailing Address - Phone:806-250-8055
Mailing Address - Fax:806-250-2611
Practice Address - Street 1:610 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3625
Practice Address - Country:US
Practice Address - Phone:806-272-7544
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 01430363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP56630Medicare UPIN