Provider Demographics
NPI:1154383933
Name:BRUNSON, LINDA S (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:BRUNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94220 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GOLD BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97444-7756
Mailing Address - Country:US
Mailing Address - Phone:541-247-3000
Mailing Address - Fax:541-247-3151
Practice Address - Street 1:500 5TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9702
Practice Address - Country:US
Practice Address - Phone:541-412-2000
Practice Address - Fax:541-469-2081
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-0937095OtherCURRY HEALTH DISTRICT TAX I.D.
OR0000ZGBDGOtherCURRY MEDICAL CENTER MEDICARE PART B
OR381322OtherCURRY MEDICAL CENTER MEDICARE PART A
C81773Medicare UPIN
ORR158993Medicare PIN