Healthcare Provider Details

I. General information

NPI: 1962518555
Provider Name (Legal Business Name): SUSAN M BRUGMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JACKSON ST J323
DENVER CO
80206-2761
US

IV. Provider business mailing address

1400 JACKSON ST
DENVER CO
80206-2761
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-4461
  • Fax: 303-270-2174
Mailing address:
  • Phone: 303-388-4461
  • Fax: 303-270-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29168
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number29168
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: