Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0103301288 | VA |
NPI | 1013440569 |
---|---|
Provider Name | Richard Bruno |
First Address | Suffolk, VA 23434-8173 |
Second Address | Suffolk, VA 23434-8173 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2017 |
Last Update Date | 28/07/2020 |