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General NPI Number Information
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NPI Number | 1881449635
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Entity Type | Individual
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Provider Name | GAGE JAMES BUNESS DO
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Gender | Male
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Dates
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Enumeration Date | 04/23/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 301 FISHER ST
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City | KEESLER AFB
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State | MS
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Zip | 39534-2508
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Country | US
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Telephone | 228-376-5571
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Fax |
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Provider Business Mailing Address
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Address Line | 3504 E CLAREMONT AVE
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City | PARADISE VALLEY
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State | AZ
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Zip | 85253-3749
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Country | US
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Telephone | 602-448-0194
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | T-5523
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License Number State | MS
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