Individual
JACK CASTEEL BRUNER II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 LEWISTON ST, COTTONWOOD, ID 83522-9750
(208) 962-3267
(208) 962-2313
Mailing address
PO BOX 565, COTTONWOOD, ID 83522-0565
(208) 962-3267
(208) 962-2313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6055
ID
208600000X
Surgery Physician
M6055
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002283800
—
ID
Enumeration date
05/24/2005
Last updated
08/06/2021
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