Provider Demographics
NPI:1588842405
Name:MARK T. BRUNE, MD CHARTERED
Entity Type:Organization
Organization Name:MARK T. BRUNE, MD CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BRUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-782-4991
Mailing Address - Street 1:1701 COUNTY RD STE H
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4465
Mailing Address - Country:US
Mailing Address - Phone:775-782-4991
Mailing Address - Fax:775-782-4997
Practice Address - Street 1:1701 COUNTY RD STE H
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4465
Practice Address - Country:US
Practice Address - Phone:775-782-4991
Practice Address - Fax:775-782-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002003251Medicaid
NVV105321Medicare PIN
NV002003251Medicaid