Provider Demographics
NPI:1851402184
Name:BRUNS, JERRY R (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:R
Last Name:BRUNS
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:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93011-0201
Mailing Address - Country:US
Mailing Address - Phone:805-388-8330
Mailing Address - Fax:805-388-8030
Practice Address - Street 1:1901 OUTLET CENTER DR
Practice Address - Street 2:SUITE220
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0663
Practice Address - Country:US
Practice Address - Phone:805-388-8330
Practice Address - Fax:805-388-8030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA415692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41569OtherLICENSE
CAA41569OtherLICENSE