=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427927094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSTEOPATHIC MEDICINE TAMPA, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2025
-----------------------------------------------------
Last Update Date | 11/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 W PLATT ST
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-485-5780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 W PLATT ST
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-2113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-485-5780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | JONATHAN BRUNER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 813-478-5780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 204D00000X
-----------------------------------------------------
Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------