Provider Demographics
NPI:1952451759
Name:BRUNER, JACK G (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:G
Last Name:BRUNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2801 K ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5118
Mailing Address - Country:US
Mailing Address - Phone:916-453-5958
Mailing Address - Fax:916-733-8290
Practice Address - Street 1:2801 K ST STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5118
Practice Address - Country:US
Practice Address - Phone:916-453-5958
Practice Address - Fax:916-733-8290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG9831208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery