Provider Demographics
NPI:1417137563
Name:BRUNS, THOMAS NC (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NC
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 1:1907 BOISE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5016
Mailing Address - Country:US
Mailing Address - Phone:970-669-2770
Mailing Address - Fax:970-669-5729
Practice Address - Street 1:1907 BOISE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5016
Practice Address - Country:US
Practice Address - Phone:970-669-2770
Practice Address - Fax:970-669-5729
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01180900Medicaid
CO01180900Medicaid