Provider Demographics
NPI:1699745943
Name:BRUS, ROBERT JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:BRUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9015 STRADA STELL CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4373
Mailing Address - Country:US
Mailing Address - Phone:239-597-5638
Mailing Address - Fax:239-597-5628
Practice Address - Street 1:9015 STRADA STELL CT
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4373
Practice Address - Country:US
Practice Address - Phone:239-597-5638
Practice Address - Fax:239-597-5628
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0005315207R00000X
FLOS 12015207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000886003Medicaid
DE0000886003Medicaid
DEG02723I14Medicare PIN