Individual
JOHN BRUNNER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3215 N NORTHHILLS BLVD, FAYETTEVILLE, AR 72703-4424
(918) 664-9892
(918) 664-2521
Mailing address
PO BOX 1867, FAYETTEVILLE, AR 72702-1867
(918) 664-9892
(918) 664-2521
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
C4438
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100073220A
—
OK
05
—
104564001
—
AR
01
—
770119201
ARKANSAS BREASTCARE
AR
Enumeration date
12/01/2005
Last updated
02/10/2012
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