Basic Information
| Provider Information | |||||||||
| NPI: | 1609829910 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUNN | ||||||||
| FirstName: | TAMARA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CAMIS | ||||||||
| OtherFirstName: | TAMARA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 TAHOMA BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | YELM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985977735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604587761 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 201 TAHOMA BLVD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | YELM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985977735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604587761 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 10/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00040895 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8298036 | 05 | WA | MEDICAID | 5192BU | 01 | WA | REGENCE | OTHER | 0158682 | 01 | WA | L&I | OTHER |