Doctor Name: | BYRON JOHN BUNAL |
NPI Number: | 1013319342 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CST |
License Number: | 152503 |
Business Practice Address: | 1061 Harmon Ave Fort Stewart, GA - 313145641 |
Business Phone Number: | 9124356050 |
Business Fax Number: | |
Mailing Address: | 1061 Harmon Ave, FORT STEWART |
State: | GA |
Postal Code: | 313145641 |
Phone Number: | 9124356050 |
Fax Number: | |
NPI Enumeration Date: | 09/18/2014 |
NPI Last Update Date: | 09/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246Z00000X |
License Number: | 152503 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | |
Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |