Provider Demographics
NPI:1013080779
Name:VANBRUGGEN, JUNE P (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:P
Last Name:VANBRUGGEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3239 WINFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2421
Mailing Address - Country:US
Mailing Address - Phone:919-489-2617
Mailing Address - Fax:919-489-7037
Practice Address - Street 1:3239 WINFIELD DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2421
Practice Address - Country:US
Practice Address - Phone:919-489-2617
Practice Address - Fax:919-489-7037
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC169642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8984666Medicaid
NC203353Medicare ID - Type Unspecified
NCC81802Medicare UPIN