MEDICARE: THOMAS L BUNNOW JR. 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	207Q00000X	Family Medicine Physician	200400018	NC

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	:	1639130875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS L BUNNOW JR. MD

Provider Business Mailing Address
First Line	:	45 PLATEAU ST
Second Line	:	SUITE 250
City	:	BRYSON CITY
State	:	NC
Zip	:	28713
Country	:	US
Telephone Number	:	828-488-4205
Fax Number	:	828-488-4240

Provider Business Practice Location Address
First Line	:	45 PLATEAU ST
Second Line	:	SUITE 250
City	:	BRYSON CITY
State	:	NC
Zip	:	28713
Country	:	US
Telephone Number	:	828-488-4205
Fax Number	:	828-488-4240

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	12/19/2011

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