Provider Demographics
NPI:1093864928
Name:BRUCKER, NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:BRUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 W 121ST PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7921
Mailing Address - Country:US
Mailing Address - Phone:303-410-8041
Mailing Address - Fax:303-410-8044
Practice Address - Street 1:3830 W 121ST PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7921
Practice Address - Country:US
Practice Address - Phone:303-410-8041
Practice Address - Fax:303-410-8044
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO90637038Medicaid