Provider Demographics
NPI:1861472003
Name:BRUNER, TERRANCE (MD)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:
Last Name:BRUNER
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 880
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0880
Mailing Address - Country:US
Mailing Address - Phone:316-685-8428
Mailing Address - Fax:316-652-0340
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5438
Practice Address - Fax:316-652-0340
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28748207ZP0102X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Not Answered207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS058736OtherBCBS
2220029506OtherRAILROAD MEDICARE
KS058736OtherBCBS
H26356Medicare UPIN