Provider Demographics
NPI:1023011913
Name:BRUNSON, ADAM A (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:A
Last Name:BRUNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 28TH ST N
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1823
Mailing Address - Country:US
Mailing Address - Phone:727-561-4303
Mailing Address - Fax:727-561-9299
Practice Address - Street 1:12225 28TH ST N
Practice Address - Street 2:SUITE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1823
Practice Address - Country:US
Practice Address - Phone:727-561-4303
Practice Address - Fax:727-561-9299
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH40249Medicare UPIN
E5720YMedicare PIN