Provider Demographics
NPI:1447227244
Name:BRUNSON, MILTON E (MD)
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:E
Last Name:BRUNSON
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:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71711-0757
Mailing Address - Country:US
Mailing Address - Phone:870-836-8101
Mailing Address - Fax:870-837-6833
Practice Address - Street 1:353 CASH RD SW
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3704
Practice Address - Country:US
Practice Address - Phone:870-836-8101
Practice Address - Fax:870-837-6833
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR110187001Medicaid
CO13282000001OtherQUALCHOICE
5295276OtherAETNA
000061219306OtherUNITED HEALTH CARE
AR7700254301OtherBREASTCARE
5295276OtherAETNA
AR50723Medicare ID - Type Unspecified