Provider Demographics
NPI:1154329332
Name:BRUSCO, OSVALDO ALEXANDRO JR (MD)
Entity Type:Individual
Prefix:MR
First Name:OSVALDO
Middle Name:ALEXANDRO
Last Name:BRUSCO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 61160
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1160
Mailing Address - Country:US
Mailing Address - Phone:361-885-0448
Mailing Address - Fax:361-857-0572
Practice Address - Street 1:5814 ESPLANADE DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414
Practice Address - Country:US
Practice Address - Phone:361-885-0448
Practice Address - Fax:361-879-0982
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2019-11-19
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Provider Licenses
StateLicense IDTaxonomies
TXK1785207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK1785OtherTEXAS MEDICAL BOARD
TX113278901Medicaid
00096DOtherBCBS
TXBB4334950OtherDEA#