Provider Demographics
NPI:1689672156
Name:BRUNT, JOEL ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:ROY
Last Name:BRUNT
Suffix:
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 1:2712 CRISWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-1143
Mailing Address - Country:US
Mailing Address - Phone:228-762-0713
Mailing Address - Fax:228-762-0712
Practice Address - Street 1:2712 CRISWELL AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-1143
Practice Address - Country:US
Practice Address - Phone:228-762-0713
Practice Address - Fax:228-762-0712
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS09811207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117494Medicaid
MS00117494Medicaid