Organization
BRUNNER SURGICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD G BRUNNER (PRESIDENT)
(850) 209-4576
Entity
Organization
Contact information
Practice address
4318 5TH AVE, MARIANNA, FL 32446-2182
(850) 209-4576
(850) 526-1323
Mailing address
2919 GREEN ST, MARIANNA, FL 32446-3345
(850) 209-4576
(850) 526-1323
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ME0046858
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02676
BCBS
FL
Enumeration date
07/28/2014
Last updated
08/12/2014
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