Healthcare Provider Details

I. General information

NPI: 1639130875
Provider Name (Legal Business Name): THOMAS L BUNNOW JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PLATEAU ST SUITE 250
BRYSON CITY NC
28713
US

IV. Provider business mailing address

45 PLATEAU ST SUITE 250
BRYSON CITY NC
28713
US

V. Phone/Fax

Practice location:
  • Phone: 828-488-4205
  • Fax: 828-488-4240
Mailing address:
  • Phone: 828-488-4205
  • Fax: 828-488-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200400018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: