Provider Demographics
NPI:1932668852
Name:BRUBAKER, DONALD QUINTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:QUINTIN
Last Name:BRUBAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4498 POTOMAC HIGHLANDS TRAIL
Mailing Address - Street 2:
Mailing Address - City:GREEN BANK
Mailing Address - State:WV
Mailing Address - Zip Code:24944
Mailing Address - Country:US
Mailing Address - Phone:304-456-5115
Mailing Address - Fax:304-456-5118
Practice Address - Street 1:4498 POTOMAC HIGHLANDS TRAIL
Practice Address - Street 2:
Practice Address - City:GREEN BANK
Practice Address - State:WV
Practice Address - Zip Code:24944
Practice Address - Country:US
Practice Address - Phone:304-456-5115
Practice Address - Fax:304-456-5118
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31524207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1932668852Medicaid