Provider Demographics
NPI:1336113729
Name:BUNTON, PHILLIP C (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:C
Last Name:BUNTON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3110 MITCHELL ST BLDG 500
Mailing Address - Street 2:P.O. BOX 2591
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-2529
Mailing Address - Country:US
Mailing Address - Phone:608-245-4684
Mailing Address - Fax:608-245-4628
Practice Address - Street 1:3110 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-2529
Practice Address - Country:US
Practice Address - Phone:608-245-4567
Practice Address - Fax:608-245-4628
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI845-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant