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General NPI Number Information
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NPI Number | 1336113729
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Entity Type | Individual
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Provider Name | PHILLIP C. BUNTON PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 3110 MITCHELL ST
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City | MADISON
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State | WI
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Zip | 53704-2529
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Country | US
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Telephone | 608-245-4567
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Fax | 608-245-4628
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Provider Business Mailing Address
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Address Line | 3110 MITCHELL ST BLDG 500 P.O. BOX 2591
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City | MADISON
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State | WI
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Zip | 53704-2529
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Country | US
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Telephone | 608-245-4684
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Fax | 608-245-4628
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 845-023
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License Number State | WI
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