Individual
CHARLIE ED BRUNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4403 HARRISON BLVD STE 3490, OGDEN, UT 84403-3284
(801) 387-2650
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 387-2650
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
44477
CO
207RC0000X
Cardiovascular Disease Physician
7752036-1205
UT
207RI0011X
Interventional Cardiology Physician
44477
CO
207RI0011X
Interventional Cardiology Physician
Primary
7752036-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18603271
—
CO
01
—
44477
STATE LICENSE
CO
Enumeration date
05/23/2006
Last updated
08/17/2022
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