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General NPI Number Information
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NPI Number | 1124522636
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Entity Type | Individual
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Provider Name | PHILIP MARC BRUNETTI MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 715 FRIARS WAY
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City | FAIRBANKS
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State | AK
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Zip | 99709-2474
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Country | US
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Telephone | 504-931-4732
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Fax |
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Provider Business Mailing Address
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Address Line | 715 FRIARS WAY
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City | FAIRBANKS
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State | AK
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Zip | 99709-2474
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 84104
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License Number State | WI
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