Provider Demographics
NPI:1992783971
Name:BRASHER, BRUCE U (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:U
Last Name:BRASHER
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:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-1000
Mailing Address - Fax:336-718-1052
Practice Address - Street 1:250 CHARLOIS BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1508
Practice Address - Country:US
Practice Address - Phone:336-718-1000
Practice Address - Fax:336-718-1052
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8918014Medicaid
C33213Medicare UPIN
NC2036944AMedicare UPIN
NC204982EMedicare ID - Type Unspecified