Provider Demographics
NPI:1225265101
Name:BRUMMEL, JARED A (DO)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:A
Last Name:BRUMMEL
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 1:225 E 2ND AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4236
Mailing Address - Country:US
Mailing Address - Phone:760-738-7224
Mailing Address - Fax:
Practice Address - Street 1:225 E 2ND AVE STE 260
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4236
Practice Address - Country:US
Practice Address - Phone:760-738-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA068121207X00000X
ALDO.1287207X00000X
CA20A10794207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147381AMedicaid
AL172042Medicaid
AL102I209711Medicare PIN
GA003147381AMedicaid