Provider Demographics
NPI:1902841174
Name:BRUMER, ELLIOTT M (DPM)
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:M
Last Name:BRUMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 W 8TH ST
Mailing Address - Street 2:#330
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4019
Mailing Address - Country:US
Mailing Address - Phone:213-385-2400
Mailing Address - Fax:213-385-2403
Practice Address - Street 1:2120 W 8TH ST
Practice Address - Street 2:#330
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4019
Practice Address - Country:US
Practice Address - Phone:213-385-2400
Practice Address - Fax:213-385-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2230213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11237Medicare UPIN
CAE2230Medicare ID - Type Unspecified