Roger S. Brunt M.D. P.a.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

M3281 Issued in ID

Legal business name

ROGER S. BRUNT M.D. P.A.

Practice address

1995 E 17TH St
Idaho Falls, ID 83404-6493

Phone

(208) 201-3737

NPI assigned

Nov 2, 2007

Last updated

Nov 2, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Roger Stevenson Brunt, M.D.

Title

President

Phone

(208) 201-3737

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193961600000",
    "number": "1922287226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1995 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046493",
            "telephone_number": "208-201-3737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046493",
            "telephone_number": "208-201-3737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGER S. BRUNT M.D. P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-02",
        "last_updated": "2007-11-02",
        "status": "A",
        "authorized_official_last_name": "BRUNT",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "STEVENSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-201-3737",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "ID",
            "license": "M3281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Primary Care Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.