Provider Demographics
NPI:1972824217
Name:BRUBACHER, JACOB W (MD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:W
Last Name:BRUBACHER
Suffix:
Gender:M
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:UNIVERSITY OF KANSAS MEDICAL CTR
Mailing Address - Street 2:MAIL STOP 3017, 3901 RAINBOW BOULEVARD
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-6100
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF KANSAS MEDICAL CTR
Practice Address - Street 2:MAIL STOP 3017, 3901 RAINBOW BOULEVARD
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-0001
Practice Address - Country:US
Practice Address - Phone:913-588-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-244081207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery