# BRADENTON SURGICAL GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164418182
- **Authorized official:** GARY M BUNCH MD (OWNER)
- **Authorized official phone:** (941) 744-2700

## Contact information

- **Practice address:** 200 3RD AVE W, STE 110, BRADENTON, FL 34205-8626
- **Practice address phone:** (941) 744-2700
- **Practice address fax:** (941) 744-2705
- **Mailing address:** 200 3RD AVE W, SUITE 110, BRADENTON, FL 34205-8626
- **Mailing address phone:** (941) 744-2700
- **Mailing address fax:** (941) 744-2705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | FL | Yes |

## Other

- **Enumeration date:** 09/26/2005
- **Last updated:** 07/21/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 7385373 | AETNA | FL |
| 01 | — | 94850 | BCBS | FL |
| 01 | — | CK2566 | RAIL ROAD MEDICARE | FL |