Provider Demographics
NPI:1073132403
Name:BRUGGER, REIS
Entity Type:Individual
Prefix:
First Name:REIS
Middle Name:
Last Name:BRUGGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 HILLCREST ST
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-1168
Mailing Address - Country:US
Mailing Address - Phone:618-645-1787
Mailing Address - Fax:
Practice Address - Street 1:2220 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:METROPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62960-1168
Practice Address - Country:US
Practice Address - Phone:618-645-1787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program