Provider Demographics
NPI:1013440569
Name:BRUNO, RICHARD RAYMOND (DPM)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RAYMOND
Last Name:BRUNO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 GODWIN BLVD STE 355
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8173
Mailing Address - Country:US
Mailing Address - Phone:757-983-8520
Mailing Address - Fax:757-579-8646
Practice Address - Street 1:2790 GODWIN BLVD STE 355
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8173
Practice Address - Country:US
Practice Address - Phone:757-983-8520
Practice Address - Fax:757-579-8646
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301288213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery