Organization
RANDALL EARL BUNDY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY EARL BUNDY LP (OWNER)
(218) 829-1063
Entity
Organization
Contact information
Practice address
510 BLUFF AVE, BRAINERD, MN 56401-2653
(218) 829-1063
Mailing address
510 BLUFF AVE, BRAINERD, MN 56401-2653
(218) 829-1063
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122361
UCARE
MN
01
—
5066093
MEDICA
MN
05
—
8115555100
—
MN
01
—
9050AD
BCBS
MN
Enumeration date
10/09/2006
Last updated
08/01/2008
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