Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34217 | CA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 34217 | CA |
NPI | 1134116957 |
---|---|
Provider Name | Stephen A. Brunton |
First Address | Winnsboro, SC 29180-5218 |
Second Address | Winnsboro, SC 29180-2411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5902263 | (05) | NC |