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General NPI Number Information
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NPI Number | 1316927775
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Entity Type | Individual
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Provider Name | ROBERT J BRUXVOORT M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 382 N 120TH AVE
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City | HOLLAND
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State | MI
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Zip | 49424-2169
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Country | US
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Telephone | 616-396-6516
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Fax | 616-396-2513
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Provider Business Mailing Address
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Address Line | 382 N 120TH AVE
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City | HOLLAND
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State | MI
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Zip | 49424-2169
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Country | US
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Telephone | 616-396-6516
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Fax | 616-396-2513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35498
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License Number State | IA
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