Bruner, Jack Casteel

Bruner, Jack Casteel is an individual health care provider with primary practice located at 701 Lewiston St , Cottonwood ID 83522-9750. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Surgery, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Bruner, Jack Casteel can be contacted via phone (208) 962-3267.

Contact Information

Primary practice address
701 Lewiston St Cottonwood ID 83522-9750
Phone: (208) 962-3267
Fax: (208) 962-2313
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X M6055 Idaho
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M6055 Idaho

Profile Details

NPI number 1982607669
LBN Legal business name Bruner, Jack Casteel
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Aug 6th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982607669 NPPES
Idaho MEDICAID 002283800

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