Provider Demographics
NPI:1982796892
Name:BRUSE, LAURA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BRUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BRUSE
Other - Last Name:GEHRIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:944 EVEREST PEAK AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-5338
Mailing Address - Country:US
Mailing Address - Phone:701-595-2878
Mailing Address - Fax:
Practice Address - Street 1:225 N 7TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4417
Practice Address - Country:US
Practice Address - Phone:701-323-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD022616207X00000X
PAMD428456207X00000X
SC29111207X00000X
ND10252207X00000X
NV15493207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ134598Medicaid