Basic Information
| Provider Information | |||||||||
| NPI: | 1427203355 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPHEN R BUNKER MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 CALIFORNIA ST | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941094586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159217226 | ||||||||
| FaxNumber: | 4159217225 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 CALIFORNIA ST | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941094586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159217226 | ||||||||
| FaxNumber: | 4159217225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2008 | ||||||||
| LastUpdateDate: | 11/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | BUNKER | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4159217226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | G36647 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0904X | G36647 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00G366471 | 05 | CA | MEDICAID |