Provider Demographics
NPI:1881786374
Name:BRUNSMAN, JOHN H
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:BRUNSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98073-2032
Mailing Address - Country:US
Mailing Address - Phone:425-885-7004
Mailing Address - Fax:425-885-0515
Practice Address - Street 1:16146 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4318
Practice Address - Country:US
Practice Address - Phone:425-885-7004
Practice Address - Fax:425-885-0515
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA246213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
38424OtherLNI
WA1394105Medicaid
480015164OtherRR MEDICARE
5486131OtherAETNA
R35952OtherREGENCE
0840100001OtherDMERC
480015164OtherRR MEDICARE
T01540Medicare UPIN
WA1394105Medicaid