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NPI Code Detail

MEDICARE: MR. DAVID L BRUXER M.S.W.

MEDICARE: MR. DAVID L BRUXER M.S.W.
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
11041C0700XClinical Social WorkerLW 00004324WA
2174400000XSpecialistLW00004324WA
3174400000XSpecialistLH00004581WA
4174400000XSpecialistLF00001420WA

General Provider Information

NPI Number : 1619970241
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID L BRUXER M.S.W.
Provider Business Mailing Address
First Line : 2003 S LIBERTY DR
Second Line :
City : LIBERTY LAKE
State : WA
Zip : 99019-9782
Country : US
Telephone Number : 509-255-6330
Fax Number : 509-747-0609
Provider Business Practice Location Address
First Line : 210 W SPRAGUE AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99201-3627
Country : US
Telephone Number : 509-343-5072
Fax Number : 509-747-0609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 06/18/2009

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