Provider Demographics
NPI:1578095030
Name:BRUNGARDT, JOSEPH GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GERARD
Last Name:BRUNGARDT
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 1:124 COMMODORE ST STE B
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-2995
Mailing Address - Country:US
Mailing Address - Phone:620-672-6454
Mailing Address - Fax:620-672-3488
Practice Address - Street 1:124 COMMODORE ST STE B
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-2995
Practice Address - Country:US
Practice Address - Phone:620-672-6454
Practice Address - Fax:620-672-3488
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.145078208600000X
GA390200000X
KS04-49070208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program