MEDICARE: DR. DAVID G BRUST MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZC0006X	Clinical Pathology Physician	S1778	TX

General Provider Information

NPI Number	:	1376582668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID G BRUST MD

Provider Business Mailing Address
First Line	:	WAKE FOREST BAPTIST MEDICAL CTR
Second Line	:	MEDICAL CENTER BOULEVARD
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-5222
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 UNIVERSITY BLVD
Second Line	:
City	:	GALVESTON
State	:	TX
Zip	:	77555-0001
Country	:	US
Telephone Number	:	409-772-2222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	11/11/2019

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