Individual
EDWARD A BRUNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1050 W 10TH ST, STE 350, ROLLA, MO 65401
(573) 458-3350
(573) 426-6247
Mailing address
PO BOX 579, ROLLA, MO 65402
(573) 458-3425
(573) 426-2282
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
31589
MO
207RG0100X
Gastroenterology Physician
Primary
31589
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130959
HEALTHLINK
MO
05
—
240502815
—
MO
05
—
24052815
—
MO
01
—
8768
BLUE CROSS BLUE SHIELD OF
MO
01
—
P00144896
RAIL ROAD MEDICARE
MO
Enumeration date
07/18/2006
Last updated
04/04/2011
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