Provider Demographics
NPI:1851493472
Name:UNRUH, BRIAN K (PA)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:UNRUH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3716
Mailing Address - Country:US
Mailing Address - Phone:785-462-6184
Mailing Address - Fax:785-460-1490
Practice Address - Street 1:310 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3716
Practice Address - Country:US
Practice Address - Phone:785-462-6184
Practice Address - Fax:785-460-1490
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500644363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100344760AMedicaid
KS15-00644OtherKANSAS LICENSE
KS100344760AMedicaid
KSS84973Medicare UPIN