Provider Demographics
NPI:1396973764
Name:BUNDY, TIMOTHY DOUGLAS (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DOUGLAS
Last Name:BUNDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 S HYDE PARK AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-4118
Mailing Address - Country:US
Mailing Address - Phone:816-916-2081
Mailing Address - Fax:813-354-3448
Practice Address - Street 1:324 S HYDE PARK AVE STE 275
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4118
Practice Address - Country:US
Practice Address - Phone:816-916-2081
Practice Address - Fax:813-354-3448
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS118052081P2900X, 2081P2900X
MO2009011529208100000X
KS0533792208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002726449OtherHIGHMARK BLUE SHIELD/MEDICARE ADVANTAGE
PA30141511OtherAMERIHEALTHCARITAS
PA1396973764OtherGEISINGER HEALTH PLAN
PA1396973764OtherCOVENTRY/HEALTH AMERICA
PA9175867OtherAETNA
PA829462OtherFPH
PA3885294000OtherAMERIHEALTH HMO/PPO/KEYSTONE
PA102705348-0001OtherDPW-NORTHAMPTON COUNTY
PA102705348-0002OtherDPW-LACKAWANNA COUNTY
PA25-1645055OtherUHC COMMUNITY/UNISON
PA5039324OtherCIGNA
PA3885294000OtherINDEPENDENCE BC
PA002726449OtherFPLIC TRADITIONAL/PPO
PA50107871OtherCAPITAL BLUE CROSS
PA102705348-0001OtherDPW-NORTHAMPTON COUNTY