Provider Demographics
NPI:1093723140
Name:BRUNE, MARK THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:BRUNE
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:PO BOX 4540
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-4540
Mailing Address - Country:US
Mailing Address - Phone:775-445-7745
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:925 IRONWOOD DR
Practice Address - Street 2:SUITE 2101
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-5178
Practice Address - Country:US
Practice Address - Phone:775-445-7745
Practice Address - Fax:775-782-0073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002003251Medicaid
NVF85250Medicare UPIN
NV002003251Medicaid