Provider Demographics
NPI:1639130875
Name:BUNNOW, THOMAS L JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:BUNNOW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 PLATEAU ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713
Mailing Address - Country:US
Mailing Address - Phone:828-488-4205
Mailing Address - Fax:828-488-4240
Practice Address - Street 1:45 PLATEAU ST
Practice Address - Street 2:SUITE 250
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713
Practice Address - Country:US
Practice Address - Phone:828-488-4205
Practice Address - Fax:828-488-4240
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200400018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891354KMedicaid
NC891354KMedicaid
2027135AMedicare ID - Type Unspecified