Provider Demographics
NPI:1508959131
Name:BRUNNER, SUSAN F (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:BRUNNER
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 1:3400 HIGHWAY 78 E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-8907
Mailing Address - Country:US
Mailing Address - Phone:205-387-4401
Mailing Address - Fax:205-387-4717
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8907
Practice Address - Country:US
Practice Address - Phone:205-387-4401
Practice Address - Fax:205-387-4717
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20106207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009915545Medicare ID - Type Unspecified
G38934Medicare UPIN
AL051553070Medicare ID - Type Unspecified