Healthcare Provider Details

I. General information

NPI: 1568934032
Provider Name (Legal Business Name): DAVID FRANCIS BRULE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 11TH AVE STE 3
EUGENE OR
97401-3370
US

IV. Provider business mailing address

220 E 11TH AVE STE 3
EUGENE OR
97401-3370
US

V. Phone/Fax

Practice location:
  • Phone: 510-289-0123
  • Fax:
Mailing address:
  • Phone: 510-289-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3020
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: