Healthcare Provider Details

I. General information

NPI: 1689672156
Provider Name (Legal Business Name): JOEL ROY BRUNT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 ANDREW AVE
PASCAGOULA MS
39567-1815
US

IV. Provider business mailing address

2712 CRISWELL AVE
PASCAGOULA MS
39567-1143
US

V. Phone/Fax

Practice location:
  • Phone: 282-762-0713
  • Fax: 287-697-4842
Mailing address:
  • Phone: 228-762-0713
  • Fax: 228-762-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMS09811
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number09811
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: