Basic Information
| Provider Information | |||||||||
| NPI: | 1255308003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUAL | ||||||||
| FirstName: | GERARDO | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 288 N IRONWOOD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | APACHE JUNCTION | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852203830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806714086 | ||||||||
| FaxNumber: | 4806714105 | ||||||||
| Practice Location | |||||||||
| Address1: | 288 N IRONWOOD | ||||||||
| Address2: | #105 | ||||||||
| City: | APACHE JUNCTION | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852203830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806714086 | ||||||||
| FaxNumber: | 4806714105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | AZ21075 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.