Healthcare Provider Details

I. General information

NPI: 1124522636
Provider Name (Legal Business Name): PHILIP MARC BRUNETTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 C ST STE 105
ANCHORAGE AK
99501-5127
US

IV. Provider business mailing address

1577 C ST STE 105
ANCHORAGE AK
99501-5127
US

V. Phone/Fax

Practice location:
  • Phone: 907-759-7440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number84104
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: