Provider Demographics
NPI:1194861849
Name:BRUNO, MATTHEW JAMES (PA C)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JAMES
Last Name:BRUNO
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 N STONEBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:972-390-9002
Mailing Address - Fax:214-491-3777
Practice Address - Street 1:1790 N STONEBRIDGE DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071
Practice Address - Country:US
Practice Address - Phone:972-390-9002
Practice Address - Fax:214-491-3777
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05067207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00658033OtherRAILROAD MEDICARE PTAN
TXP00658033OtherRAILROAD MEDICARE PTAN