Provider Demographics
NPI:1427218528
Name:BRUNGARDT, MARK JOHN (NMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOHN
Last Name:BRUNGARDT
Suffix:
Gender:M
Credentials:NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10581 W 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-7326
Mailing Address - Country:US
Mailing Address - Phone:303-489-1433
Mailing Address - Fax:
Practice Address - Street 1:1280 CENTAUR VILLAGE DR STE 8
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-1255
Practice Address - Country:US
Practice Address - Phone:303-926-1575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist