Individual
WILLIAM L BUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2350 N ROCKTON AVE, ROCKFORD, IL 61103-3600
(815) 971-7255
(815) 971-9955
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-5356
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036131963
IL
208600000X
Surgery Physician
20030056
NM
2086S0120X
Pediatric Surgery Physician
Primary
04-23862
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35326751
—
NM
Enumeration date
03/22/2007
Last updated
11/22/2016
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