Individual
GREGORY CARL BRUNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
31 SANDSTONE CIR, JACKSON, TN 38305-2073
(731) 240-1747
Mailing address
PO BOX 11955, JACKSON, TN 38308-0132
(888) 630-0845
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
38350
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3893872
—
TN
05
—
3893873
—
TN
05
—
3893874
—
TN
01
—
4084444
BCBS
—
01
—
4102695
BCBS
—
01
—
P00109823
RR MEDICARE
—
Enumeration date
03/02/2006
Last updated
09/24/2024
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