Basic Information
| Provider Information | |||||||||
| NPI: | 1548326374 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUNK | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | RAYMOND | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 OLD GATESBURG RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142373122 | ||||||||
| FaxNumber: | 8142374050 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 OLD GATESBURG RD STE 310 | ||||||||
| Address2: | |||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142373122 | ||||||||
| FaxNumber: | 8142374050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 11/13/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS014280 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.