Individual
GREGORY MILLETTE BUNCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
45 CASTRO ST, SUITE 121, SAN FRANCISCO, CA 94114-1010
(415) 456-5613
(415) 864-1654
Mailing address
45 CASTRO ST, SUITE 121, SAN FRANCISCO, CA 94114-1010
(877) 276-7759
(720) 493-8807
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
G49617
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G496170
—
CA
01
—
OOG496170
BLUE SHIELD
CA
Enumeration date
11/04/2005
Last updated
10/14/2008
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