Provider Demographics
NPI:1912934191
Name:BRUNE, CARL WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:WILLIAM
Last Name:BRUNE
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 1:1050 RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5400
Mailing Address - Country:US
Mailing Address - Phone:843-524-3378
Mailing Address - Fax:843-524-8179
Practice Address - Street 1:1050 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5400
Practice Address - Country:US
Practice Address - Phone:843-524-3378
Practice Address - Fax:843-524-1879
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0295972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00401596AMedicaid
SCG29597OtherSOUTH CAROLINA MEDICAID
GA00401596AMedicaid
GA26BDBHFMedicare ID - Type Unspecified