Provider Demographics
NPI:1336114016
Name:BRUBAKER, WILLIAM KENT (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KENT
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 E MORTEN
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-589-0370
Mailing Address - Fax:602-589-0650
Practice Address - Street 1:1747 E MORTEN
Practice Address - Street 2:SUITE 303
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-589-0370
Practice Address - Fax:602-589-0650
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD36612Medicare UPIN
AZWDBRDMedicare ID - Type Unspecified