Provider Demographics
NPI:1306950506
Name:BRUGGMAN, LINDA (RD)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:BRUGGMAN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5992 MACKEY RANCH RD
Mailing Address - Street 2:
Mailing Address - City:EDDY
Mailing Address - State:TX
Mailing Address - Zip Code:76524-2642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5992 MACKEY RANCH RD
Practice Address - Street 2:
Practice Address - City:EDDY
Practice Address - State:TX
Practice Address - Zip Code:76524-2642
Practice Address - Country:US
Practice Address - Phone:254-859-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered