Individual
JAMES M. BRUNGARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Mailing address
600 COFFEE RD, MODESTO, CA 95355-4201
(209) 524-1211
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C39363
CA
2086S0129X
Vascular Surgery Physician
C39363
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C393630
—
CA
Enumeration date
05/16/2006
Last updated
05/27/2010
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