Provider Demographics
NPI:1801645478
Name:BRUTON, BRANDI (DO)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BRUTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:PA
Mailing Address - Zip Code:17936-0352
Mailing Address - Country:US
Mailing Address - Phone:816-519-7147
Mailing Address - Fax:
Practice Address - Street 1:200 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3660
Practice Address - Country:US
Practice Address - Phone:570-621-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT023482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine