Provider Demographics
NPI:1629080239
Name:BRUMM, BRUCE HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:HAROLD
Last Name:BRUMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6751 N 72ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1746
Mailing Address - Country:US
Mailing Address - Phone:402-572-2020
Mailing Address - Fax:402-572-2150
Practice Address - Street 1:6751 N 72ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1746
Practice Address - Country:US
Practice Address - Phone:402-572-2020
Practice Address - Fax:402-572-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13621207W00000X
IA20580207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01690OtherBCBS OF NE
NE47067295013Medicaid
NE6465OtherMIDLANDS CHOICE
IA0941856Medicaid
NE87648OtherCOVENTRY
IA94185OtherWELLMARK
NE87648OtherCOVENTRY
NE265622Medicare ID - Type UnspecifiedPERFORMING PROVIDER NUMBE
NE47067295013Medicaid