Healthcare Provider Details

I. General information

NPI: 1407826258
Provider Name (Legal Business Name): WILLIAM CHARLES BRUNNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

641 GARFIELD ST
OCEANSIDE CA
92054-4211
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1356
  • Fax: 760-725-0117
Mailing address:
  • Phone: 504-452-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number194615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: