Provider Demographics
NPI:1619970241
Name:BRUXER, DAVID L (MSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:BRUXER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 S LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-9782
Mailing Address - Country:US
Mailing Address - Phone:509-255-6330
Mailing Address - Fax:509-747-0609
Practice Address - Street 1:210 W SPRAGUE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3627
Practice Address - Country:US
Practice Address - Phone:509-343-5072
Practice Address - Fax:509-747-0609
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 000043241041C0700X
WALW00004324174400000X
WALH00004581174400000X
WALF00001420174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000304522Medicare ID - Type Unspecified