Healthcare Provider Details

I. General information

NPI: 1699743062
Provider Name (Legal Business Name): ADRIANA M. BRUNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2773 NW 9TH STREET BRUNE DERMATOLOGY, LLC
CORVALLIS OR
97330
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMD28131
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD28131
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: