Healthcare Provider Details

I. General information

NPI: 1184616112
Provider Name (Legal Business Name): JOAN ELIZABETH BRUNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SCOTT ST
ALEXANDRIA LA
71301-8131
US

IV. Provider business mailing address

425 SCOTT ST
ALEXANDRIA LA
71301-8131
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-7355
  • Fax: 318-487-8035
Mailing address:
  • Phone: 318-445-7355
  • Fax: 318-487-8035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number61-17296
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number017125
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: