=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780684332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD EVANS BRUNER DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 09/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 N 7TH ST
-----------------------------------------------------
City | CHAMBERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17201-1720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-217-4300
-----------------------------------------------------
Fax | 717-221-7421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 MEMORY LN
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17402-2231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-851-1405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 5101010451
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | OS014943
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------