# DR. PHILLIP MARK BRUNER

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1114902590
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | ME62537 | FL | — |
| 207V00000X | Obstetrics & Gynecology Physician | MD-42240 | IA | Yes |

## Other

- **Enumeration date:** 12/08/2005
- **Last updated:** 02/04/2015

## 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 |