Individual
KENNETH R. BUNNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3714 GUARDIAN AVE, SUITE E, MOREHEAD CITY, NC 28557-2974
(252) 247-2101
Mailing address
3714 GUARDIAN AVE, MOREHEAD CITY, NC 28557-2974
(222) 247-2101
(252) 247-4675
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
2011-01863
NC
208800000X
Urology Physician
Primary
OS9814
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117472
OPERATING ENGINEERS
FL
05
—
279031900
—
FL
01
—
344465
AVMED
FL
01
—
7137932
AETNA PROVIDER #
FL
01
—
94655
BCBS
FL
01
—
P00468955
RAILROAD MEDICARE
FL
Enumeration date
06/06/2007
Last updated
04/24/2013
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