MEDICARE: MR. MARSHALL JAY BRUMER 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	207RP1001X	Pulmonary Disease Physician	ME0016806	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922071141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARSHALL JAY BRUMER MD

Provider Business Mailing Address
First Line	:	3001 NW 49TH AVE
Second Line	:	307
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313
Country	:	US
Telephone Number	:	954-484-8990
Fax Number	:	954-739-3732

Provider Business Practice Location Address
First Line	:	3001 NW 49TH AVE
Second Line	:	307
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-7266
Country	:	US
Telephone Number	:	954-484-8990
Fax Number	:	954-739-3732

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	01/19/2011

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