=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932240587
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAWRENCE E BRUNEL , M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 09/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 GREENLEY RD SUITE 920
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370-5287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-532-5121
-----------------------------------------------------
Fax | 209-532-6017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 GREENLEY RD SUITE 920
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370-5287
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-532-5121
-----------------------------------------------------
Fax | 209-532-6017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LAWRENCE E BRUNEL
-----------------------------------------------------
Credential | M.D. F.A.C.O.G.
-----------------------------------------------------
Telephone | 209-532-5121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G286930
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------