Provider Demographics
NPI:1497810915
Name:BRUNEAU, DENNIS M (PA-C)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:BRUNEAU
Suffix:
Gender:M
Credentials:PA-C
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 3300
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-3300
Mailing Address - Country:US
Mailing Address - Phone:541-576-2343
Mailing Address - Fax:541-576-2869
Practice Address - Street 1:87520 BAY RD
Practice Address - Street 2:
Practice Address - City:CHRISTMAS VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97641-0377
Practice Address - Country:US
Practice Address - Phone:541-576-2343
Practice Address - Fax:541-576-2869
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
970003593OtherMEDICARE RAILROAD
OR182817Medicaid
S30220Medicare UPIN