Provider Demographics
NPI:1689891806
Name:BRUEN, ERICA RYBERG (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:RYBERG
Last Name:BRUEN
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 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 310W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6900
Mailing Address - Fax:406-238-6939
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 310W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6900
Practice Address - Fax:406-238-6939
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6024873-1205207R00000X
FLME101431207R00000X
MT12367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515ZMedicare PIN