Provider Demographics
NPI:1134178791
Name:BRUST, DOUGLAS G (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:G
Last Name:BRUST
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:3661 S MIAMI AVE STE 806
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4223
Practice Address - Country:US
Practice Address - Phone:786-497-4000
Practice Address - Fax:305-854-0111
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2025-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME95136207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274652200Medicaid
FL274652200Medicaid
FL37134WMedicare UPIN