Gerald Frank Bunting-Blake, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

31378 Issued in AZ

Practice address

5380 E Kachina St
Davis Monthan a F B, AZ 85707-4923

Phone

(520) 228-4926

NPI assigned

Dec 29, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195084800000",
    "number": "1417934662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 E GOLF AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852824031",
            "telephone_number": "480-201-0781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5380 E KACHINA ST",
            "city": "DAVIS MONTHAN A F B",
            "state": "AZ",
            "postal_code": "857074923",
            "telephone_number": "520-228-4926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNTING-BLAKE",
        "first_name": "GERALD",
        "middle_name": "FRANK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2007-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "31378",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "13051",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "31378",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NE",
            "license": "13051",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Boehler, MSW
• Savanna Dawn Bowers, DNP, FNP-C
• Brett G Brazier, DO
• Michael David Brewer, MD
• Patricia Ann Bridges, RPH
• Diamond Byrd
• Justin Chiasson, IDMT
• Brett Myungsoo Chung, DDS
• Jayme L Cline, IDMT
• Amanda Cook, DO

• Psychiatry Physician in Davis Monthan AFB, AZ
• Providers in Davis Monthan AFB, AZ by specialty
• Psychiatry Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.