Provider Demographics
NPI:1215039961
Name:BRUNKER, CHERIE PRATT (MD)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:PRATT
Last Name:BRUNKER
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 1:8TH AVE. & C STREET
Mailing Address - Street 2:LDS HOSPITAL
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84143
Mailing Address - Country:US
Mailing Address - Phone:801-408-8616
Mailing Address - Fax:
Practice Address - Street 1:LDS HOSPITAL
Practice Address - Street 2:8TH AVE. & C STREET
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143-0001
Practice Address - Country:US
Practice Address - Phone:801-408-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1788571205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF67127Medicare UPIN
UT000062226Medicare PIN
UT000062484Medicare PIN