Provider Demographics
NPI:1396766317
Name:FLUGSRUD-BRECKENRIDGE, MARCIA REED (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:REED
Last Name:FLUGSRUD-BRECKENRIDGE
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HEUBNER ROAD
Mailing Address - Street 2:
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442
Mailing Address - Country:US
Mailing Address - Phone:785-239-7581
Mailing Address - Fax:785-240-8358
Practice Address - Street 1:IACH
Practice Address - Street 2:650 HEUBNER RD
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5808
Practice Address - Country:US
Practice Address - Phone:386-755-3016
Practice Address - Fax:386-758-3212
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME454572084P0800X, 2084P2900X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4A826Medicare ID - Type Unspecified
D69031Medicare UPIN