MEDICARE: JOHN A BRUNS

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	246XS1301X	Sonography Specialist/Technologist Cardiovascular

General Provider Information

NPI Number	:	1356475693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A BRUNS

Provider Business Mailing Address
First Line	:	17627 123RD TER N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-4677
Country	:	US
Telephone Number	:	954-471-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	3907 N FEDERAL HWY
Second Line	:	#139
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6042
Country	:	US
Telephone Number	:	954-471-8322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	11/05/2007

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