Provider Demographics
NPI:1720075823
Name:BRUMMETT, DAVID P (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BRUMMETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1502 E BROADWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8076
Mailing Address - Country:US
Mailing Address - Phone:573-443-4591
Mailing Address - Fax:573-874-1369
Practice Address - Street 1:1502 E BROADWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8076
Practice Address - Country:US
Practice Address - Phone:573-443-4591
Practice Address - Fax:573-874-1369
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020065042085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205811300Medicaid
MO013010303Medicare ID - Type Unspecified
MO205811300Medicaid