Healthcare Provider Details

I. General information

NPI: 1194724641
Provider Name (Legal Business Name): DOUGLAS A BRUNS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MITCHELL AVE
BATESVILLE IN
47006-8909
US

IV. Provider business mailing address

PO BOX 236
BATESVILLE IN
47006-0236
US

V. Phone/Fax

Practice location:
  • Phone: 812-933-5018
  • Fax: 812-933-5472
Mailing address:
  • Phone: 812-933-5441
  • Fax: 812-933-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34006256B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: