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NPI Code Detail

MEDICARE: PAUL A. BRUNDAGE D.O.

MEDICARE: PAUL A. BRUNDAGE D.O.
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
1207RG0100XGastroenterology Physician3945545TN

General Provider Information

NPI Number : 1629011549
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL A. BRUNDAGE D.O.
Provider Business Mailing Address
First Line : 2415 CHAMBLISS AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-3882
Country : US
Telephone Number : 423-559-2800
Fax Number : 423-559-0532
Provider Business Practice Location Address
First Line : 2415 CHAMBLISS AVE NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37311-3882
Country : US
Telephone Number : 423-559-2800
Fax Number : 423-559-0532
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 10/05/2015

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Directions to “ PAUL A. BRUNDAGE D.O.” Practice Location

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