MEDICARE: DR. MARK WILSON BRUNVAND 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	207RH0003X	Hematology & Oncology Physician	26243	CO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891779534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WILSON BRUNVAND MD

Provider Business Mailing Address
First Line	:	4900 S MONACO ST
Second Line	:	SUITE 210
City	:	DENVER
State	:	CO
Zip	:	80237-3486
Country	:	US
Telephone Number	:	720-754-4800
Fax Number	:	720-754-4801

Provider Business Practice Location Address
First Line	:	1721 E 19TH AVE
Second Line	:	STE 300
City	:	DENVER
State	:	CO
Zip	:	80218-1251
Country	:	US
Telephone Number	:	720-754-4800
Fax Number	:	720-754-4801

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	02/07/2014

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