MEDICARE: ADAM A BRUNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	ME980751	FL
2	207Q00000X	Family Medicine Physician	ME80751	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023011913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM A BRUNSON M.D.

Provider Business Mailing Address
First Line	:	12225 28TH ST N STE B
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-1860
Country	:	US
Telephone Number	:	727-561-4303
Fax Number	:	727-561-9299

Provider Business Practice Location Address
First Line	:	12225 28TH ST N STE B
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-1860
Country	:	US
Telephone Number	:	727-561-4303
Fax Number	:	727-561-9299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/24/2025

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Directions to “ ADAM A BRUNSON M.D.” Practice Location

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