Provider Demographics
NPI:1083610117
Name:BRUCKMEIER, KURT F (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:F
Last Name:BRUCKMEIER
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 1:101 ASBURY CIR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1302
Mailing Address - Country:US
Mailing Address - Phone:601-268-5200
Mailing Address - Fax:601-268-5211
Practice Address - Street 1:101 ASBURY CIR
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1302
Practice Address - Country:US
Practice Address - Phone:601-268-5200
Practice Address - Fax:601-268-5211
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09945207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00016251Medicaid
P00064618OtherRAILROAD MEDICARE
MS00016251Medicaid
MS110001683Medicare PIN