Provider Demographics
NPI:1689642514
Name:BRUNSON, JAMES H JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:BRUNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1245
Mailing Address - Country:US
Mailing Address - Phone:803-395-4497
Mailing Address - Fax:803-536-0998
Practice Address - Street 1:1170 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4359
Practice Address - Country:US
Practice Address - Phone:803-533-0042
Practice Address - Fax:803-536-5220
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8154207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5077175OtherAETNA
SC081547Medicaid
SC9167890OtherCIGNA
SC9167890OtherCIGNA
SC081547Medicaid
SCD178595677Medicare PIN