Jack Casteel Bruner II, MD
Family Medicine in Cottonwood, ID. Individual provider (NPI-1).
NPI number1982607669
StatusActive
Last updated in NPPESAug 6, 2021
Details
- NPI
- 1982607669
- Entity type
- Individual (NPI-1)
- Name
- Jack Casteel Bruner II
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 24, 2005
- Certification date
- Aug 5, 2021
- Last updated
- Aug 6, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | M6055 | ID | Yes |
| 208600000X | Surgery | M6055 | ID |
Practice location
701 Lewiston StCottonwood, ID 83522-9750
Phone 208-962-3267 · Fax 208-962-2313
Mailing address
Po Box 565Cottonwood, ID 83522-0565
Phone 208-962-3267 · Fax 208-962-2313
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