Provider Demographics
NPI:1073615704
Name:KATUNA, BRUCE ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALAN
Last Name:KATUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 ONYX CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-7805
Mailing Address - Country:US
Mailing Address - Phone:303-776-5298
Mailing Address - Fax:303-682-2785
Practice Address - Street 1:1511 ONYX CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-7805
Practice Address - Country:US
Practice Address - Phone:303-776-5298
Practice Address - Fax:303-682-2785
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0030103204R00000X
CODR.00301032084N0400X
CO379432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO017732OtherKAISER COMMERCIAL NUMBER
CO01301035Medicaid
TN46095OtherMED LIC
CO017732OtherKAISER COMMERCIAL NUMBER
CO01301035Medicaid