Provider Demographics
NPI:1053441121
Name:BRUNING, KARLA VINECE BOLTON (MD)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:VINECE BOLTON
Last Name:BRUNING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BYPASS LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-8413
Mailing Address - Country:US
Mailing Address - Phone:936-327-3843
Mailing Address - Fax:936-327-7132
Practice Address - Street 1:300 BYPASS LN
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-8413
Practice Address - Country:US
Practice Address - Phone:936-327-3843
Practice Address - Fax:936-327-7132
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG85822Medicare UPIN