Randolph Allen Brunner, LAT/ATC
Individual provider Active NPI Athletic Trainer · Junction City, OR
NPI 1740964832 · NPPES record last updated Jun 9, 2023
Key facts
- NPI
- 1740964832
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Athletic Trainer 2255A2300X
- License
- AT-AT-10193515 (OR)
- Practice address
- 27033 Ferguson Rd
Junction City, OR 97448-9320 - Phone
- (541) 729-3609
- NPI assigned
- Jun 9, 2023
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-AT-10193515 | OR | MD | Athletic Trainer |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT-AT-10193515 | OR | Yes |
Addresses
Primary practice location
27033 Ferguson Rd
Junction City, OR 97448-9320
Mailing address
27033 Ferguson Rd
Junction City, OR 97448-9320
Phone (541) 729-3609
Other providers in Junction City, OR
- Chenoa Lorraine Bostick
- Adrianna B Breitmeier
- Michael Edward Bressert
- Glen Briscoe
- Larita Fay Brown
- Gordon K Bullock
- Kaitlyn Nicole Buntin
- Anthony Burnett
- Connie Ruth Burns
- Christyann Martinez Byrd
All providers in Junction City, OR · Athletic Trainer in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.