Individual
ZACHERY M BRUNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
393 E 2ND N, REXBURG, ID 83440
(208) 356-5401
(208) 356-3111
Mailing address
393 E 2ND N, REXBURG, ID 83440-1605
(208) 356-5401
(208) 356-3111
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-607
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807432900
—
ID
Enumeration date
06/22/2006
Last updated
04/13/2020
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