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General NPI Number Information
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NPI Number | 1679956205
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Entity Type | Individual
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Provider Name | SCOTT C BRUN MD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 1 N WAUKEGAN RD DEPT R435, BLDG AP30-3
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City | NORTH CHICAGO
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State | IL
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Zip | 60064-1802
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Country | US
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Telephone | 847-935-1293
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Fax | 847-938-3711
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Provider Business Mailing Address
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Address Line | 31048 PRAIRIE RIDGE RD
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-4898
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Country | US
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Telephone | 847-935-1293
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036095736
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License Number State | IL
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