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General NPI Number Information
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NPI Number | 1447296785
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Entity Type | Individual
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Provider Name | ZACHERY M BRUNSON PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 393 E 2ND N
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City | REXBURG
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State | ID
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Zip | 83440
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Country | US
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Telephone | 208-356-5401
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Fax | 208-356-3111
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Provider Business Mailing Address
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Address Line | 393 E 2ND N
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City | REXBURG
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State | ID
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Zip | 83440-1605
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Country | US
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Telephone | 208-356-5401
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Fax | 208-356-3111
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-607
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License Number State | ID
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