Provider Demographics
NPI:1699947192
Name:KUNZLER, BRENT TIMOTHY (PA)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:TIMOTHY
Last Name:KUNZLER
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:490 PAINTBRUSH WAY
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8319
Mailing Address - Country:US
Mailing Address - Phone:435-272-9239
Mailing Address - Fax:
Practice Address - Street 1:207 W LEGION RD
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7780
Practice Address - Country:US
Practice Address - Phone:760-351-3130
Practice Address - Fax:760-351-3137
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19659363A00000X
AK186486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant