Individual
TIMOTHY G BRUNI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9454 THREE RIVERS RD, SUITE A, GULFPORT, MS 39503-4294
(228) 864-7747
(228) 864-7415
Mailing address
9454 THREE RIVERS RD, SUITE A, GULFPORT, MS 39503-4294
(228) 864-7747
(228) 864-7415
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
15527
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00120712
—
MS
05
—
09015616
—
MS
01
—
640935888
TAX IDENTIFICATION
MS
Enumeration date
08/31/2006
Last updated
03/22/2011
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