1497586549 NPI number — MR. WILLIAM LAMAR BUNTON SR. MA, RIC

Table of content: DONNA C SMITH M.A. (NPI 1518959071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497586549 NPI number — MR. WILLIAM LAMAR BUNTON SR. MA, RIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUNTON
Provider First Name:
WILLIAM
Provider Middle Name:
LAMAR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
MA, RIC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497586549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2921 REPLICA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23703-5218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-275-5240
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
999 WATERSIDE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23510-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-977-8455
Provider Business Practice Location Address Fax Number:
757-765-6450
Provider Enumeration Date:
08/12/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0704016964 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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