Provider Demographics
NPI:1033547070
Name:GREGORY BRUNET
Entity Type:Organization
Organization Name:GREGORY BRUNET
Other - Org Name:URGENT ORTHO PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRUNET
Authorized Official - Suffix:I
Authorized Official - Credentials:PA
Authorized Official - Phone:805-896-7594
Mailing Address - Street 1:936 CAMINO DEL RETIRO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1005
Mailing Address - Country:US
Mailing Address - Phone:805-896-7594
Mailing Address - Fax:805-686-9140
Practice Address - Street 1:936 CAMINO DEL RETIRO
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1005
Practice Address - Country:US
Practice Address - Phone:805-896-7594
Practice Address - Fax:805-686-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA15590OtherLICENSE#
CAPA15590OtherLICENSE#
CAP65360Medicare UPIN