Provider Demographics
NPI:1083197537
Name:FLUGUM, BRANDON SCOTT
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:SCOTT
Last Name:FLUGUM
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:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:MANLY
Mailing Address - State:IA
Mailing Address - Zip Code:50456-0175
Mailing Address - Country:US
Mailing Address - Phone:641-590-1609
Mailing Address - Fax:
Practice Address - Street 1:105 S IOWA ST
Practice Address - Street 2:
Practice Address - City:MANLY
Practice Address - State:IA
Practice Address - Zip Code:50456-7748
Practice Address - Country:US
Practice Address - Phone:641-590-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA734ZZ0755344600000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi