Dr Laura Brunner, MD | |
1001 Noble St, Fairbanks, AK 99701-4922 | |
(907) 459-3520 | |
(907) 459-3526 |
Full Name | Dr Laura Brunner |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 1001 Noble St, Fairbanks, Alaska |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1184770778 | NPI | - | NPPES |
1009375 | Medicaid | AK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 6588 (Alaska) | Primary |
208000000X | Pediatrics | 47809 (Colorado) | Secondary |
Entity Name | Tanana Valley Clinic Llc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1922559558 PECOS PAC ID: 5698056901 Enrollment ID: O20161228001991 |
Mailing Address | Practice Location Address |
---|---|
Dr Laura Brunner, MD 1001 Noble St, Fairbanks, AK 99701-4922 Ph: (907) 459-3500 | Dr Laura Brunner, MD 1001 Noble St, Fairbanks, AK 99701-4922 Ph: (907) 459-3520 |
Dr. James Timothy Foote, M.D. Pediatrics Medicare: Accepting Medicare Assignments Practice Location: 1001 Noble St, Fairbanks, AK 99701 Phone: 907-459-3520 Fax: 907-459-3554 | |
Dr. Marvin Bergeson, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1001 Noble St, Fairbanks, AK 99701 Phone: 907-459-3520 Fax: 907-459-3526 | |
Dr. Mishelle Nace, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 1001 Noble St, Fairbanks, AK 99701 Phone: 907-459-3520 Fax: 907-459-3554 | |
Dr. Corneliu Antonescu, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1001 Noble St, Fairbanks, AK 99701 Phone: 907-459-3520 Fax: 907-459-3554 | |
Dr. John Matthew De Pasquale, MD, MPH, DTM&H Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1001 Noble St, Fairbanks, AK 99701 Phone: 907-459-3520 Fax: 907-459-3554 | |
Manal Shihadeh, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1919 Lathrop St Ste 204, Fairbanks, AK 99701 Phone: 907-374-2637 Fax: 907-374-2632 |