Provider Demographics
NPI:1972599959
Name:BRUNER, ROBERT KINCAID (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KINCAID
Last Name:BRUNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4201 LAKE BOONE TRL STE 104
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7511
Mailing Address - Country:US
Mailing Address - Phone:919-881-0160
Mailing Address - Fax:919-881-0887
Practice Address - Street 1:4201 LAKE BOONE TRL
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7512
Practice Address - Country:US
Practice Address - Phone:919-881-0160
Practice Address - Fax:919-881-0887
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC37797207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0190EOtherBCBS
060021506OtherRAILROAD MEDICARE
2550133OtherUNITED HEALTHCARE
NC8919342Medicaid
238010OtherMAMSI
52133OtherMEDCOST
8469OtherPARTNERS
5727215OtherAETNA
2185013AMedicare ID - Type Unspecified
52133OtherMEDCOST