MEDICARE: DR. CORY RENE BRUNE DO

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	207L00000X	Anesthesiology Physician	2022015495	MO

General Provider Information

NPI Number	:	1376049510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CORY RENE BRUNE DO

Provider Business Mailing Address
First Line	:	PO BOX 104240
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65110-4240
Country	:	US
Telephone Number	:	573-556-7765
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 W EDGEWOOD DR
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-6902
Country	:	US
Telephone Number	:	573-556-7765
Fax Number	:

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

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	06/20/2024

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