Provider Demographics
NPI:1073625257
Name:BRUDENELL, ROSS NATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:NATHAN
Last Name:BRUDENELL
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3801 LAKE OTIS PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5234
Mailing Address - Country:US
Mailing Address - Phone:907-562-2277
Mailing Address - Fax:907-563-3460
Practice Address - Street 1:3801 LAKE OTIS PKWY
Practice Address - Street 2:STE 300
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5234
Practice Address - Country:US
Practice Address - Phone:907-562-2277
Practice Address - Fax:907-563-3460
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK1664207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2560Medicaid
AKMD2560Medicaid
AK151649Medicare PIN