Healthcare Provider Details

I. General information

NPI: 1801833660
Provider Name (Legal Business Name): CRAIG DAVID BARTRUFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 10TH ST
GOTHENBURG NE
69138-2063
US

IV. Provider business mailing address

PO BOX 389
GOTHENBURG NE
69138-0389
US

V. Phone/Fax

Practice location:
  • Phone: 308-537-3674
  • Fax: 308-537-3675
Mailing address:
  • Phone: 308-537-3674
  • Fax: 308-537-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12802
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: