Provider Demographics
NPI:1437100302
Name:BRUNO, DEBORA SANTOS (MD)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:SANTOS
Last Name:BRUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7385
Mailing Address - Country:US
Mailing Address - Phone:402-460-5899
Mailing Address - Fax:402-460-5619
Practice Address - Street 1:815 N KANSAS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4470
Practice Address - Country:US
Practice Address - Phone:402-460-5899
Practice Address - Fax:402-460-5619
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23664207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE249581OtherMIDLANDS CHOICE
NE30418OtherBLUE CROSS BLUE SHIELD
KS200385920AMedicaid
NE10025662600Medicaid
KS200385920AMedicaid
280122Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
NEP00049954Medicare ID - Type UnspecifiedRAILROAD MEDICARE IND NUM