Provider Demographics
NPI:1629182449
Name:BRUNNER, ALEXANDER J (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:J
Last Name:BRUNNER
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 1:1113 MURFREESBORO RD
Mailing Address - Street 2:SUITE 319
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-1306
Mailing Address - Country:US
Mailing Address - Phone:615-790-0567
Mailing Address - Fax:615-595-8030
Practice Address - Street 1:122 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-3340
Practice Address - Country:US
Practice Address - Phone:615-790-0567
Practice Address - Fax:931-422-2074
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40245207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440828Medicaid
TN083121OtherBOARD CERTIFICATION #
TN40245OtherMEDICAL LICENSE#