Basic Information
| Provider Information | |||||||||
| NPI: | 1316086606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUNKER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1326 PAPERMILL POINTE WAY | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652193506 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 281 UNDERPASS DR | ||||||||
| Address2: | |||||||||
| City: | ONEIDA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235695454 | ||||||||
| FaxNumber: | 4235695902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 04/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | MD53986 | TN | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081P2900X | 049851 | GA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081P2900X | 53986 | TN | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01779038 | 01 | GA | AMERIGROUP | OTHER | P01193373 | 01 | GA | RR MEDICARE | OTHER | Q022991 | 05 | TN | MEDICAID | 466485 | 01 | GA | WELLCARE | OTHER | 451469306D | 05 | GA | MEDICAID |