Basic Information
| Provider Information | |||||||||
| NPI: | 1629080239 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUMM | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | HAROLD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6751 N 72ND ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722020 | ||||||||
| FaxNumber: | 4025722150 | ||||||||
| Practice Location | |||||||||
| Address1: | 6751 N 72ND ST | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681221746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025722020 | ||||||||
| FaxNumber: | 4025722150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 13621 | NE | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 20580 | IA | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 01690 | 01 | NE | BCBS OF NE | OTHER | 47067295013 | 05 | NE | MEDICAID | 6465 | 01 | NE | MIDLANDS CHOICE | OTHER | 0941856 | 05 | IA | MEDICAID | 87648 | 01 | NE | COVENTRY | OTHER | 94185 | 01 | IA | WELLMARK | OTHER |