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General NPI Number Information
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NPI Number | 1164418182
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Entity Type | Organization
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Legal Business Name | BRADENTON SURGICAL GROUP PA
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 200 3RD AVE W STE 110
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City | BRADENTON
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State | FL
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Zip | 34205-8626
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Country | US
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Telephone | 941-744-2700
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Fax | 941-744-2705
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Provider Business Mailing Address
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Address Line | 200 3RD AVE W SUITE 110
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City | BRADENTON
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State | FL
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Zip | 34205-8626
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Country | US
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Telephone | 941-744-2700
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Fax | 941-744-2705
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Authorized Official
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Title or Position | OWNER
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Name | GARY M BUNCH
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Credential | MD
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Telephone | 941-744-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State | FL
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