Healthcare Provider Details

I. General information

NPI: 1508508896
Provider Name (Legal Business Name): JOHN EDWARD BRUS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BAKER AVE
WHITEFISH MT
59937-2901
US

IV. Provider business mailing address

1111 BAKER AVE
WHITEFISH MT
59937-2901
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-2515
  • Fax: 406-862-4229
Mailing address:
  • Phone: 406-862-2515
  • Fax: 406-862-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number164033
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: