Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 125-055283 | IL |
Y | 207QS0010X | Family Doctor - Sports Medicine | ME113046 | FL |
NPI | 1245493089 |
---|---|
Provider Name | Brunel Joseph |
First Address | Spring Hill, FL 34609-8102 |
Second Address | Tampa, FL 33607-6511 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 31/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007344700 | (05) | FL |
14ME0 | BCBS (01) | FL |
P01125558 | RR MCR (01) | FL |