Individual
MR. CHARLES BRUNNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
506 GALE ST, LAREDO, TX 78041-6003
(956) 724-9091
(956) 724-8213
Mailing address
7210 MCPHERSON RD, SUITE 115, LAREDO, TX 78041-6507
(956) 722-8046
(956) 722-8047
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00370
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TX
Enumeration date
06/10/2015
Last updated
01/11/2016
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