Provider Demographics
NPI:1306496732
Name:BUNCE, GRADY PAUL (ELECTROLOGIST)
Entity type:Individual
Prefix:
First Name:GRADY
Middle Name:PAUL
Last Name:BUNCE
Suffix:
Gender:M
Credentials:ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-0115
Mailing Address - Country:US
Mailing Address - Phone:541-852-6182
Mailing Address - Fax:
Practice Address - Street 1:2525 CAL YOUNG RD FL 3
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6477
Practice Address - Country:US
Practice Address - Phone:541-852-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10195171246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other