Provider Demographics
NPI:1699880609
Name:BRUMFIEL, BRUCE A (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BRUMFIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4244 INDIAN RIPPLE RD.
Mailing Address - Street 2:STE. 300
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45440-7709
Mailing Address - Country:US
Mailing Address - Phone:937-429-0674
Mailing Address - Fax:
Practice Address - Street 1:4244 INDIAN RIPPLE RD
Practice Address - Street 2:STE 300
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3279
Practice Address - Country:US
Practice Address - Phone:937-429-3366
Practice Address - Fax:937-429-0956
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033638B207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000010664OtherANTHEM
OHD33638OtherHUMANA
OHP00362836OtherRAILROAD MEDICARE
OH1059OtherNATIONWIDE
310964774OtherTAX ID
OH4050965OtherAETNA
OH0320013OtherUHC
OH0409334Medicare PIN
OH0320013OtherUHC