MEDICARE: SANDRA D.M. BRUNO, M.D., LLC

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	020956	LA

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	:	1295868024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA D.M. BRUNO, M.D., LLC

Provider Business Mailing Address
First Line	:	217 SAM HOUSTON JONES PKWY
Second Line	:	SUITE 101
City	:	LAKE CHARLES
State	:	LA
Zip	:	70611-5603
Country	:	US
Telephone Number	:	337-217-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 SAM HOUSTON JONES PKWY
Second Line	:	SUITE 101
City	:	LAKE CHARLES
State	:	LA
Zip	:	70611-5603
Country	:	US
Telephone Number	:	337-217-1000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SANDRA D BRUNO
Credential	:	MD
Telephone Number	:	337-217-1000

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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