Provider Demographics
NPI:1336586544
Name:BOUNKEU, BRIAND DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAND
Middle Name:DANIEL
Last Name:BOUNKEU
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 1:1856 ADAGIO DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-4816
Mailing Address - Country:US
Mailing Address - Phone:678-992-3814
Mailing Address - Fax:
Practice Address - Street 1:4055 VALLEY VIEW LN STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5071
Practice Address - Country:US
Practice Address - Phone:972-715-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME145596208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program