Basic Information
| Provider Information | |||||||||
| NPI: | 1376049510 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNE | ||||||||
| FirstName: | CORY | ||||||||
| MiddleName: | RENE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3520 W EDGEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651096902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5735567765 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SOUTH POINTE HOSPITAL | ||||||||
| Address2: | 20000 HARVARD RD | ||||||||
| City: | WARRENSVILLE HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164916000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2018 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2022015495 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.