Individual
DR. KIMBERLY ANN BRUNO-DE LA MATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
13506 SUMMERPORT VILLAGE PKWY, #341, WINDERMERE, FL 34786-7366
(865) 363-3330
Mailing address
1200 J D ANDERSON DR, MORGANTOWN, WV 26505-3494
(304) 598-1200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME101735
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3856126
—
TN
01
—
4103352
BLUE CROSS
TN
01
—
P00284603
RRGA
TN
Enumeration date
05/25/2006
Last updated
12/11/2023
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