Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 35077 | CA |
Y | 213EG0000X | General Practice | 35077 | CA |
NPI | 1003947292 |
---|---|
Provider Name | Dr. Michael Brunner |
First Address | Healdsburg, CA 95448-0823 |
Second Address | Healdsburg, CA 95448-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 22/01/2019 |