MEDICARE: BRETT R BUNKER P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	107486	NY
2	363A00000X	Physician Assistant	011768	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013055425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT R BUNKER P.A.

Provider Business Mailing Address
First Line	:	6163 BIRCHWOOD RD
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-1801
Country	:	US
Telephone Number	:	315-263-8645
Fax Number	:

Provider Business Practice Location Address
First Line	:	9677 BREWERTON RD
Second Line	:
City	:	BREWERTON
State	:	NY
Zip	:	13029-8738
Country	:	US
Telephone Number	:	315-668-3908
Fax Number	:	315-668-3946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	11/15/2011

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