MEDICARE: PHILIP MARC BRUNETTI MD

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	207W00000X	Ophthalmology Physician	84104	WI

General Provider Information

NPI Number	:	1124522636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP MARC BRUNETTI MD

Provider Business Mailing Address
First Line	:	1577 C ST STE 105
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1577 C ST STE 105
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-5127
Country	:	US
Telephone Number	:	907-759-7440
Fax Number	:

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

Provider Enumeration Date	:	03/20/2018
Last Update Date	:	06/24/2026

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