Provider Demographics
NPI:1316086606
Name:BUNKER, TIMOTHY R (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:BUNKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 PAPERMILL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1903
Mailing Address - Country:US
Mailing Address - Phone:865-219-3506
Mailing Address - Fax:
Practice Address - Street 1:281 UNDERPASS DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841
Practice Address - Country:US
Practice Address - Phone:423-569-5454
Practice Address - Fax:423-569-5902
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD539862081P2900X
GA0498512081P2900X
TN539862081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01779038OtherAMERIGROUP
GAP01193373OtherRR MEDICARE
TNQ022991Medicaid
GA466485OtherWELLCARE
GA451469306DMedicaid
TN103I728588Medicare PIN
GA451469306DMedicaid
TN103I722964Medicare PIN