Provider Demographics
NPI:1205836186
Name:BRUNER, WARNER LEE III (MD)
Entity Type:Individual
Prefix:DR
First Name:WARNER
Middle Name:LEE
Last Name:BRUNER
Suffix:III
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 1:710 COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6511
Mailing Address - Country:US
Mailing Address - Phone:225-927-5325
Mailing Address - Fax:225-927-4150
Practice Address - Street 1:710 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6511
Practice Address - Country:US
Practice Address - Phone:225-927-5325
Practice Address - Fax:225-927-4150
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014051207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF2509OtherBLUE CROSS
LA1359335Medicaid
LAB62956Medicare UPIN