Provider Demographics
NPI:1255951679
Name:BUNTON, SEDRICK DEWAYNE
Entity type:Individual
Prefix:MR
First Name:SEDRICK
Middle Name:DEWAYNE
Last Name:BUNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 HAVENWOOD CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-2091
Mailing Address - Country:US
Mailing Address - Phone:281-832-6142
Mailing Address - Fax:832-222-2700
Practice Address - Street 1:2923 HAVENWOOD CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-2091
Practice Address - Country:US
Practice Address - Phone:281-832-6142
Practice Address - Fax:832-222-2700
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-26
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service