Healthcare Provider Details

I. General information

NPI: 1649212432
Provider Name (Legal Business Name): ROSEBURG ANESTHESIOLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 NW STEWART PKWY
ROSEBURG OR
97470-1281
US

IV. Provider business mailing address

PO BOX 94383
SEATTLE WA
98124-6683
US

V. Phone/Fax

Practice location:
  • Phone: 541-673-0611
  • Fax:
Mailing address:
  • Phone: 503-372-2740
  • Fax: 503-372-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BART JOSEPH BRUNS
Title or Position: PRESIDENT
Credential: MD
Phone: 503-372-2740