Healthcare Provider Details

I. General information

NPI: 1093037210
Provider Name (Legal Business Name): BRUNE DERMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 NW 9TH ST
CORVALLIS OR
97330-2141
US

IV. Provider business mailing address

1740 NW 9TH ST
CORVALLIS OR
97330-2141
US

V. Phone/Fax

Practice location:
  • Phone: 541-230-1350
  • Fax: 541-207-3477
Mailing address:
  • Phone: 541-230-1350
  • Fax: 541-207-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAITLIN M COYLE
Title or Position: MANAGER
Credential:
Phone: 541-230-1350