Provider Demographics
NPI:1083699342
Name:BRUBAKER, RICK (DO)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 S PARKER RD
Mailing Address - Street 2:STE 206
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1622
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:2550 S PARKER RD
Practice Address - Street 2:STE 206
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1622
Practice Address - Country:US
Practice Address - Phone:303-306-7783
Practice Address - Fax:303-306-7753
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25761207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01257617Medicaid
CO01257617Medicaid
COE60996Medicare UPIN