Basic Information
| Provider Information | |||||||||
| NPI: | 1922443191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUNO | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ALDEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 232 NW 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972093609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032941681 | ||||||||
| FaxNumber: | 8666290091 | ||||||||
| Practice Location | |||||||||
| Address1: | 232 NW 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972093609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032941681 | ||||||||
| FaxNumber: | 8666290091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2013 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0083860 | MD | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD0207460 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.