Healthcare Provider Details

I. General information

NPI: 1558302125
Provider Name (Legal Business Name): TIMOTHY E BRUYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 5TH #400 WEST
SPOKANE WA
99204
US

IV. Provider business mailing address

104 W 5TH #400 WEST
SPOKANE WA
99204
US

V. Phone/Fax

Practice location:
  • Phone: 509-353-3960
  • Fax: 509-343-0134
Mailing address:
  • Phone: 509-353-3960
  • Fax: 509-343-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberMD00017383
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: