Healthcare Provider Details

I. General information

NPI: 1316895378
Provider Name (Legal Business Name): ELI BRUECKNER SKOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BROOKE ARMY MEDICAL CENTER, MCHE-MDX, INTERNAL MEDICINE RESIDENCY, 3551 ROGER BROOKE DR., JBSA-FORT SAM HOUSTON
APO AA
78234-4504
US

IV. Provider business mailing address

BROOKE ARMY MEDICAL CENTER, MCHE-MDX, INTERNAL MEDICINE RESIDENCY, 3551 ROGER BROOKE DR., JBSA-FORT SAM HOUSTON
APO AA
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 210-292-3410
  • Fax: 210-292-7868
Mailing address:
  • Phone: 210-292-3410
  • Fax: 210-292-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: