Provider Demographics
NPI:1134407398
Name:BRUN, ROBERT L (PA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:BRUN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:13500 CHENAL PKWY APT 304
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-5371
Mailing Address - Country:US
Mailing Address - Phone:219-670-5480
Mailing Address - Fax:219-836-1014
Practice Address - Street 1:102 GREGOR MENDEL CIR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2315
Practice Address - Country:US
Practice Address - Phone:864-229-2663
Practice Address - Fax:864-229-5694
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2020-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC3473363A00000X
IN127092246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant