Healthcare Provider Details

I. General information

NPI: 1841610037
Provider Name (Legal Business Name): GLAUBER BRUNO PEREIRA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2014
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 S RIFE MEDICAL LN STE T20
ROGERS AR
72758-1469
US

IV. Provider business mailing address

2708 S RIFE MEDICAL LN STE T20
ROGERS AR
72758-1469
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3089
  • Fax:
Mailing address:
  • Phone: 479-338-3080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberE-12963
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberE-12963
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: