Provider Demographics
NPI:1154392942
Name:BRUCKNER, JAMES DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DAVID
Last Name:BRUCKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE STE 320
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-392-3030
Mailing Address - Fax:425-392-2564
Practice Address - Street 1:3101 NORTHUP WAY STE 201
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1435
Practice Address - Country:US
Practice Address - Phone:425-455-3600
Practice Address - Fax:425-455-3920
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027573207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2022327Medicaid
WA0180310OtherL & I
WAG8801228OtherMEDICARE POSM
WAP0154442OtherMEDICARE RR KING CO.
WAG8901824OtherMEDICARE EMRI