LARRY R BRUNZLICK (NPI# 1770646721) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770646721 |
Entity Type | Individual |
Full Name | LARRY R BRUNZLICK |
Credential | MD |
Practice Address |
135 South Gibson Street Medford WI 54451 |
Practice Telephone | 7157488100 |
Practice Fax Number | 7157487590 |
Mailing Telephone | 7157488100 |
Enumeration Date | 2006-12-19 |
Last Update Date | 2012-05-15 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
24477 | WI | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
WI | 30461100 | 05 |
Street Address |
135 SOUTH GIBSON STREET |
City | MEDFORD |
State | WI |
Zip Code | 54451 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558372706 | Sammy U Rehman | Radiology | 135 South Gibson Street, Medford, WI 54451-1622 | 2006-08-11 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710536321 | Bone & Joint Clinic S.c. | Durable Medical Equipment & Medical Supplies | 724 S. 8th St, Medford, WI 54451 | 2019-09-06 |
1215474671 | Heidi Marie Nernberger | Dental Hygienist | 124 S. Main Street, Medford, WI 54451 | 2017-01-24 |
1497152656 | Rachel E Nichols | Dental Hygienist | 124 South Main St, Medford, WI 54451 | 2014-12-03 |
1811305360 | Amanda Mosse | Social Worker | 10649 W Perkinstown Ave, Medford, WI 54451 | 2014-07-29 |
1891081113 | Debra Jeanne Zenner | Nurse Practitioner | 143 South Gibson St., Medford, WI 54451 | 2011-06-24 |
1033445036 | Greg George Schoofs II | Ophthalmology | N 4803 Wigwam Ave, Medford, WI 54451 | 2009-10-26 |
1558511295 | Aspirus Medford Hospital & Clinics, Inc. | Clinic/Center | 111 S Gibson St, Medford, WI 54451 | 2008-09-30 |
1013132430 | Aspirus Medford Hospital & Clinics, Inc. | Pharmacy | 139 S Gibson St, Medford, WI 54451 | 2007-04-13 |
1356566707 | Peter G Kiefer | Pharmacist | 139 South Gibson St, Medford, WI 54451 | 2007-04-13 |
1851426753 | Steven Todd Dietzman | Specialist/Technologist | 103 South Gibson Street, Medford, WI 54451 | 2007-02-22 |
Find all providers in zip 54451 |
Taxonomy Code | 207PE0004X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Emergency Medicine |
Specialization | Emergency Medical Services |
An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649235219 | Victoria V Harris | Emergency Medicine | 100 E. Main Street, Suite C, Medford, OR 97501-6041 | 2006-04-18 |
1700818697 | Eric Richard Jensen | Emergency Medicine | 2825 E. Barnett Rd, Medford, OR 97504-8332 | 2006-07-07 |
1366407934 | Kenneth R Buccino | Emergency Medicine | 100 E. Main Street, Suite C, Medford, OR 97501-6041 | 2006-04-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144703653 | Quinton Jarrett Peters | Emergency Medicine | 1204 S Jefferson St, Appleton, WI 54915-1726 | 2018-09-11 |
1497792139 | John A Culp | Emergency Medicine | 1446 N Randall Ave, Janesville, WI 53545-1122 | 2006-06-01 |
1861440505 | Alice C Bustos | Emergency Medicine | 7220 W National Ave, West Allis, WI 53214-4734 | 2006-05-05 |
1184690133 | Manuel A. Rivera | Emergency Medicine | 5000 Memorial Dr, Two Rivers, WI 54241-3900 | 2006-02-28 |
1942588132 | Watertown Regional Medical Center, Inc | Emergency Medicine | 125 Hospital Dr, Watertown, WI 53098-3303 | 2011-07-22 |
1366692287 | James John Macneal | Emergency Medicine | 1000 Mineral Point Ave, Janesville, WI 53548-2940 | 2008-09-28 |
1669563763 | Scott A Hathaway | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-27 |
1639279383 | Rajeshwar Hanmiah | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-23 |
1598863334 | George E Vidalakis | Emergency Medicine | 309 N Bartlett St, Shawano, WI 54166-2127 | 2006-09-20 |
1548378367 | John Malcolm Mckichan | Emergency Medicine | 11040 N State Road 77, Hayward, WI 54843-6391 | 2006-08-29 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.