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Individual
DR. PHILLIP MARK BRUNER
Active
Individual
DR. PHILLIP MARK BRUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME62537
FL
207V00000X
Obstetrics & Gynecology Physician
Primary
MD-42240
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00162435
RAILROAD MEDICARE
—
01
—
17750
BLUE SHIELD
FL
01
—
198234
HEALTHEASE
FL
01
—
208117
AVMED
—
01
—
3456144
AETNA
—
05
—
370763600
—
FL
Enumeration date
12/08/2005
Last updated
02/04/2015
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