Provider Demographics
NPI:1548281744
Name:BRUNI, HAMILTON C (MD)
Entity type:Individual
Prefix:
First Name:HAMILTON
Middle Name:C
Last Name:BRUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 ISLANDER DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8802
Mailing Address - Country:US
Mailing Address - Phone:985-641-0101
Mailing Address - Fax:
Practice Address - Street 1:106 SMART PL # A
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2040
Practice Address - Country:US
Practice Address - Phone:985-781-4747
Practice Address - Fax:985-649-9907
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL013508207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1154725Medicaid
LA50287Medicare ID - Type Unspecified
LA1154725Medicaid