Provider Demographics
NPI:1376669150
Name:BRUEGGEMAN, PATRICK KENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:KENT
Last Name:BRUEGGEMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-0004
Mailing Address - Country:US
Mailing Address - Phone:321-508-7378
Mailing Address - Fax:
Practice Address - Street 1:5176 FORMOSA CIR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967
Practice Address - Country:US
Practice Address - Phone:321-508-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2457213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU52360Medicare UPIN
FL1315390001Medicare NSC