Provider Demographics
NPI:1740433945
Name:BRUBAKER, JACOB WELLINGTON (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:WELLINGTON
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1515 RESPONSE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4805
Mailing Address - Country:US
Mailing Address - Phone:916-649-1515
Mailing Address - Fax:916-649-1516
Practice Address - Street 1:1515 RESPONSE RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4805
Practice Address - Country:US
Practice Address - Phone:916-649-1515
Practice Address - Fax:916-649-1516
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA124655207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist