Basic Information
| Provider Information | |||||||||
| NPI: | 1316227473 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUNER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2820 WALLACE CT | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376645832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239678283 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 15TH ST NW | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242731616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766799600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2011 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ED0135B | WV | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 0102203269 | VA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1316227473 | 05 | VA | MEDICAID |