Provider Demographics
NPI:1922071141
Name:BRUMER, MARSHALL JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:JAY
Last Name:BRUMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 NW 49TH AVE
Mailing Address - Street 2:307
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-484-8990
Mailing Address - Fax:954-739-3732
Practice Address - Street 1:3001 NW 49TH AVE
Practice Address - Street 2:307
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7266
Practice Address - Country:US
Practice Address - Phone:954-484-8990
Practice Address - Fax:954-739-3732
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016806207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054909600Medicaid
FL78060Medicare ID - Type Unspecified
FL054909600Medicaid