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1710906011

NPI Code Detail

MEDICARE: DAVID C BRUNELLE MD

MEDICARE: DAVID C BRUNELLE MD

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	208000000X	Pediatrics Physician	MD00032102	WA
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	MD00032102	WA

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	:	1710906011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C BRUNELLE MD

Provider Business Mailing Address
First Line	:	2901 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4614
Country	:	US
Telephone Number	:	253-534-7000
Fax Number	:	253-534-7099

Provider Business Practice Location Address
First Line	:	2901 BRIDGEPORT WAY W
Second Line	:
City	:	UNIVERSITY PLACE
State	:	WA
Zip	:	98466-4614
Country	:	US
Telephone Number	:	253-534-7000
Fax Number	:	253-534-7099

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/22/2021

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Directions to “ DAVID C BRUNELLE MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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