Healthcare Provider Details

I. General information

NPI: 1104914530
Provider Name (Legal Business Name): WILLIAM J BRUNSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MAIN
WILLISTON ND
58801
US

IV. Provider business mailing address

1102 MAIN
WILLISTON ND
58801
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-7711
  • Fax: 701-572-2283
Mailing address:
  • Phone: 701-572-7711
  • Fax: 701-572-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10067
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: