Provider Demographics
NPI:1265442032
Name:BRUNS, WILLIAM CARL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CARL
Last Name:BRUNS
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 1860
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1860
Mailing Address - Country:US
Mailing Address - Phone:402-680-8332
Mailing Address - Fax:970-668-0651
Practice Address - Street 1:320 N 6TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-1860
Practice Address - Country:US
Practice Address - Phone:402-680-8332
Practice Address - Fax:970-668-0651
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ301152084P0800X
WI157982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ775702Medicaid
WI000000907OtherMEDICARE PT B
AZ775702Medicaid
AZB67610Medicare UPIN