Provider Demographics
NPI:1457601361
Name:BRUNNER, NATHAN WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WALTER
Last Name:BRUNNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 WELCH RD # MODULARB
Mailing Address - Street 2:VERA MOULTON WALL CENTER
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5102
Mailing Address - Country:US
Mailing Address - Phone:650-721-6510
Mailing Address - Fax:
Practice Address - Street 1:1215 WELCH RD
Practice Address - Street 2:MODULAR B VERA MOULTON WALL CENTER
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5414
Practice Address - Country:US
Practice Address - Phone:650-721-6510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122130207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease