Provider Demographics
NPI:1952572174
Name:BUNNAGE, BRANDON BLAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:BLAINE
Last Name:BUNNAGE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:550 GAGE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:1100 GOETHALS DRIVE 2ND FLOOR
Practice Address - Street 2:KADLEC CLINIC GENERAL & COLORECTAL SURGERY
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3304
Practice Address - Country:US
Practice Address - Phone:509-942-3185
Practice Address - Fax:509-946-1850
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016461208600000X
WAOP60119141208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0261833OtherLABOR & INDUSTRIES
WA8894153Medicare PIN