MEDICARE: KATHLEEN WEBB PUNGER 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	2011-004433	NC

General Provider Information

NPI Number	:	1679740161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN WEBB PUNGER MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 BONBROOK DRIVE
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27106-0000
Country	:	US
Telephone Number	:	336-713-5393
Fax Number	:

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

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	12/03/2014

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