Provider Demographics
NPI:1942344213
Name:BUNNELL, BRENT E (DO)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:E
Last Name:BUNNELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W ARBROOK BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3107
Mailing Address - Country:US
Mailing Address - Phone:817-467-0240
Mailing Address - Fax:817-472-9385
Practice Address - Street 1:400 W ARBROOK BLVD STE 240
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3107
Practice Address - Country:US
Practice Address - Phone:817-467-0240
Practice Address - Fax:817-472-9385
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103017303Medicaid
TX103017305Medicaid
TX103017305Medicaid
TX8K1081Medicare PIN
TX103017303Medicaid