Provider Demographics
NPI:1154351484
Name:BRUNEL, LAWRENCE EUGENE (MD FACOG)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:BRUNEL
Suffix:
Gender:M
Credentials:MD FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12811 COVEY CIR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5935
Mailing Address - Country:US
Mailing Address - Phone:209-536-5196
Mailing Address - Fax:209-533-9983
Practice Address - Street 1:12811 COVEY CIR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5935
Practice Address - Country:US
Practice Address - Phone:209-536-5196
Practice Address - Fax:209-533-9983
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28693207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G286930Medicaid
CAHA308ZMedicare PIN
CAE84236Medicare UPIN