MEDICARE: JAMES E BRUNS OD A PROFESSIONAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	CA5247	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306112362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES E BRUNS OD A PROFESSIONAL

Provider Business Mailing Address
First Line	:	6180 STATE FARM DR
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2135
Country	:	US
Telephone Number	:	707-584-7294
Fax Number	:	707-584-4728

Provider Business Practice Location Address
First Line	:	6180 STATE FARM DR
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2135
Country	:	US
Telephone Number	:	707-584-7294
Fax Number	:	707-584-4728

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LESLIE C BORDI
Credential	:
Telephone Number	:	707-584-7294

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	12/19/2013

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