Healthcare Provider Details

I. General information

NPI: 1184823643
Provider Name (Legal Business Name): JONATHAN BRUNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MATT BRUNSON M.D.

II. Dates (important events)

Enumeration Date: 07/15/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HERITAGE WAY STE 2100
KALISPELL MT
59901-3167
US

IV. Provider business mailing address

350 HERITAGE WAY STE 2100
KALISPELL MT
59901-3167
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-8992
  • Fax: 406-257-8996
Mailing address:
  • Phone: 406-257-8992
  • Fax: 406-257-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number41013
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: