MEDICARE: MR. GREGORY THOMAS BRUNET PA-C

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	363AS0400X	Surgical Physician Assistant	PA15590	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA15590	OTHER	CA	CA STATE LICENSE

General Provider Information

NPI Number	:	1013060128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY THOMAS BRUNET PA-C

Provider Business Mailing Address
First Line	:	936 CAMINO DEL RETIRO
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-1005
Country	:	US
Telephone Number	:	805-681-5095
Fax Number	:

Provider Business Practice Location Address
First Line	:	936 CAMINO DEL RETIRO
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93110-1005
Country	:	US
Telephone Number	:	805-681-5095
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/09/2007

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