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1710950647

NPI Code Detail

MEDICARE: CHARLES E BRUERD D.O.

MEDICARE: CHARLES E BRUERD D.O.

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	207L00000X	Anesthesiology Physician	A1098-98	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	050062432	OTHER	NM	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10002369	OTHER	NM	LOVELACE HP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	201016403	OTHER	NM	PRESBYTERIAN HP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	NM004B05	OTHER	NM	BCBS

General Provider Information

NPI Number	:	1710950647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES E BRUERD D.O.

Provider Business Mailing Address
First Line	:	1515 E 20TH ST
Second Line	:	SUITE A
City	:	FARMINGTON
State	:	NM
Zip	:	87401-9039
Country	:	US
Telephone Number	:	505-326-6400
Fax Number	:	505-326-4606

Provider Business Practice Location Address
First Line	:	801 W MAPLE ST
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5630
Country	:	US
Telephone Number	:	505-326-6400
Fax Number	:	505-326-4606

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	01/05/2012

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Directions to “ CHARLES E BRUERD D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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