Provider Demographics
NPI:1043439920
Name:BRUNER, BRYAN CHRISTOPHE (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:CHRISTOPHE
Last Name:BRUNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:STE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:214-826-6021
Practice Address - Fax:682-223-5006
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN49681208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00728952OtherRAILROAD MEDICARE
MN707685000Medicaid
MN707685000Medicaid
MNP00728952OtherRAILROAD MEDICARE