MEDICARE: MARK THOMAS BRUNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	7134	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093723140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK THOMAS BRUNE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4540
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-4540
Country	:	US
Telephone Number	:	775-445-7745
Fax Number	:	775-852-6902

Provider Business Practice Location Address
First Line	:	925 IRONWOOD DR
Second Line	:	SUITE 2101
City	:	MINDEN
State	:	NV
Zip	:	89423-5178
Country	:	US
Telephone Number	:	775-445-7745
Fax Number	:	775-782-0073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	09/18/2014

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