Individual
DR. PHILLIP MARK BRUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
418 E POLK ST, WASHINGTON, IA 52353-1237
(319) 653-2229
(319) 653-5040
Mailing address
418 E POLK ST, WASHINGTON, IA 52353-1237
(319) 653-2229
(319) 653-5040
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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