Provider Demographics
NPI:1578539318
Name:BRUNING, GARY L (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:BRUNING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:800 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1443
Mailing Address - Country:US
Mailing Address - Phone:660-626-2222
Mailing Address - Fax:660-626-2470
Practice Address - Street 1:800 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1443
Practice Address - Country:US
Practice Address - Phone:660-626-2222
Practice Address - Fax:660-626-2150
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015035924207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO11042435OtherHEALTHLINK
SD1538OtherDAKOTACARE
SDAH9081017522OtherPREFERRED ONE
SD5603157Medicaid
SD68889OtherARAZ/AMERICA'S PPO
SD22283OtherMIDLANDS CHOICE
MN659S4BROtherCC SYSTEMS BLUE PLUS
MN272787100Medicaid
SD4995981OtherBCBS OF SOUTH DAKOTA
MO11042435OtherANTHEM
SD5603156Medicaid
SD57028A003OtherWPS TRICARE
MN659S4BROtherBCBS OF MN
MO11042435OtherHEALTHLINK
SD5603156Medicaid
MN659S4BROtherCC SYSTEMS BLUE PLUS
MO108400077Medicare PIN