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General NPI Number Information
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NPI Number | 1427272129
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Entity Type | Individual
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Provider Name | BRIDGET SUZANNE BRUNNER M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 304 BLACKWELL DAIRY RD
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City | JASPER
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State | AL
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Zip | 35504-8406
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Country | US
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Telephone | 205-384-4801
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Fax |
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Provider Business Mailing Address
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Address Line | 304 BLACKWELL DAIRY RD
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City | JASPER
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State | AL
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Zip | 35504-8406
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Country | US
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Telephone | 205-384-4801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 28185
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License Number State | AL
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