Provider Demographics
NPI:1912975160
Name:BRUNINGA, HAROLD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:JAY
Last Name:BRUNINGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2125 SOUTHBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-9201
Mailing Address - Country:US
Mailing Address - Phone:217-243-7274
Mailing Address - Fax:
Practice Address - Street 1:900 CAPITAL AIRPORT DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62707-8410
Practice Address - Country:US
Practice Address - Phone:217-473-7386
Practice Address - Fax:217-473-7386
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-12
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036073892207W00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology