Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD17705 | RI |
N | 207R00000X | Internist | LP03995 | RI |
N | 111NI0900X | Internist | LP03995 | RI |
NPI | 1013446590 |
---|---|
Provider Name | Tal Buntinx |
First Address | Middletown, RI 02842-5237 |
Second Address | Middletown, RI 02842-5237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 28/07/2021 |