Individual
DALE L. BRUNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
910 WALLACE AVE, LEITCHFIELD, KY 42754-2414
(270) 259-1656
(270) 259-9536
Mailing address
910 WALLACE AVE, LEITCHFIELD, KY 42754-2414
(270) 259-1656
(270) 259-9536
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
30101
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1069832
PASSPORT HEALTH PLAN
KY
01
—
2434820000
PASSPORT ADVANTAGE
KY
05
—
64301013
—
KY
Enumeration date
05/03/2006
Last updated
10/23/2008
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