Provider Demographics
NPI:1073531851
Name:BUNTROCK, CHRIS T (MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:T
Last Name:BUNTROCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8801 HORIZON BLVD NE STE 360
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1563
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:622 W MAPLE ST STE E
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6589
Practice Address - Country:US
Practice Address - Phone:505-325-4003
Practice Address - Fax:505-327-6140
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-06-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0653207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73022543Medicaid
MNE63468Medicare UPIN
MN932815700Medicaid