1124020318 NPI number — BRIAN JAMES BRUENING M.D.

Table of content: JOCELYN CHEN DDS (NPI 1316745052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124020318 NPI number — BRIAN JAMES BRUENING M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRUENING
Provider First Name:
BRIAN
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124020318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4515 MARSHA SHARP FWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79407-2520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-744-7223
Provider Business Mailing Address Fax Number:
806-740-3325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3525 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-687-8346
Provider Business Practice Location Address Fax Number:
888-856-2848
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , with the licence number:  H1268 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: H1268 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109364100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 300109582 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 87451Y . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 136990209 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 625753 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: X8325 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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