Provider Demographics
NPI:1467559526
Name:BRUBAKER, DANIEL B (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:BRUBAKER
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 1:3726 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-5601
Mailing Address - Country:US
Mailing Address - Phone:559-248-0116
Mailing Address - Fax:559-248-0119
Practice Address - Street 1:3726 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-5601
Practice Address - Country:US
Practice Address - Phone:559-248-0116
Practice Address - Fax:559-248-0119
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA020A53070207ZI0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZI0100XAllopathic & Osteopathic PhysiciansPathologyImmunopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB58262Medicaid
CAB58262Medicaid