1578539318 NPI number — DR. GARY L BRUNING DO

Table of content: DR. GARY L BRUNING DO (NPI 1578539318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578539318 NPI number — DR. GARY L BRUNING DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUNING
Provider First Name:
GARY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1578539318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W JEFFERSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIRKSVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63501-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-626-2222
Provider Business Mailing Address Fax Number:
660-626-2470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKSVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63501-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-626-2222
Provider Business Practice Location Address Fax Number:
660-626-2150
Provider Enumeration Date:
02/23/2006

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: 207Q00000X , with the licence number:  2015035924 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11042435 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1538 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: AH9081017522 . This is a "PREFERRED ONE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 5603157 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68889 . This is a "ARAZ/AMERICA'S PPO" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 22283 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 659S4BR . This is a "CC SYSTEMS BLUE PLUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 272787100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4995981 . This is a "BCBS OF SOUTH DAKOTA" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 11042435 . This is a "ANTHEM" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5603156 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57028A003 . This is a "WPS TRICARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 659S4BR . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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