Individual
DR. MATTHEW JUSTIN BRUNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 982-0168
(417) 820-8852
Mailing address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 982-0168
(417) 820-8852
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
05-34533
KS
207L00000X
Anesthesiology Physician
Primary
2005025705
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386798189
—
MO
05
—
200662760A
—
OK
05
—
216316003
—
AR
01
—
P01787086
RAIL ROAD MEDICARE
MO
Enumeration date
01/22/2007
Last updated
06/11/2019
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