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General NPI Number Information
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NPI Number | 1427439033
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Entity Type | Individual
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Provider Name | CHARLES BRUNNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/10/2015
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 506 GALE ST
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City | LAREDO
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State | TX
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Zip | 78041-6003
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Country | US
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Telephone | 956-724-9091
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Fax | 956-724-8213
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Provider Business Mailing Address
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Address Line | 7210 MCPHERSON RD SUITE 115
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City | LAREDO
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State | TX
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Zip | 78041-6507
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Country | US
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Telephone | 956-722-8046
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Fax | 956-722-8047
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00370
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License Number State | TX
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