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NPI Code Detail

MEDICARE: JACOB PAUL BRUCKER II DO

MEDICARE: JACOB PAUL BRUCKER II DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician58.032632OH

General Provider Information

NPI Number : 1457001489
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB PAUL BRUCKER II DO
Provider Business Mailing Address
First Line : 2145 N FAIRFIELD RD STE 100
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45431-2783
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2145 N FAIRFIELD RD STE 100
Second Line :
City : BEAVERCREEK
State : OH
Zip : 45431-2783
Country : US
Telephone Number : 937-558-3900
Fax Number : 937-558-3999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2022
Last Update Date : 04/06/2026

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Directions to “ JACOB PAUL BRUCKER II DO” Practice Location

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