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General NPI Number Information
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NPI Number | 1083890594
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Entity Type | Organization
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Legal Business Name | THOMAS E. BRUDERLY, DO, LLC
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 04/18/2009
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Provider Practice Location Address
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Address Line | 201 5TH ST NE SUITE 3
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City | BARBERTON
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State | OH
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Zip | 44203-3017
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Country | US
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Telephone | 330-848-0123
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Fax | 330-848-1493
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Provider Business Mailing Address
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Address Line | 201 5TH ST NE SUITE 3
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City | BARBERTON
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State | OH
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Zip | 44203-3017
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Country | US
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Telephone | 330-848-0123
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Fax | 330-848-1493
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. THOMAS E BRUDERLY
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Credential | DO
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Telephone | 330-848-0123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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