Provider Demographics
NPI:1427184571
Name:BRUST, JAMES STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:BRUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2403 S MORAY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-4342
Mailing Address - Country:US
Mailing Address - Phone:310-832-7943
Mailing Address - Fax:310-514-8017
Practice Address - Street 1:2403 S MORAY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-4342
Practice Address - Country:US
Practice Address - Phone:310-832-7943
Practice Address - Fax:310-514-8017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG234232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90816Medicare UPIN
CAG23423Medicare ID - Type Unspecified