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General NPI Number Information
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NPI Number | 1780866210
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Entity Type | Organization
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Legal Business Name | FAIRFAX OAKTON FOOT CENTER LTD
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 400B HOSPITAL DR
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City | WARRENTON
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State | VA
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Zip | 20186-3026
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Country | US
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Telephone | 540-347-1370
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Fax | 540-349-4801
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Provider Business Mailing Address
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Address Line | 400B HOSPITAL DR
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City | WARRENTON
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State | VA
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Zip | 20186-3026
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Country | US
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Telephone | 540-347-1370
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Fax | 540-349-4801
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN ROBERT BUNT
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Credential | DPM
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Telephone | 540-347-1370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 01030000604
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License Number State | VA
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