Basic Information
| Provider Information | |||||||||
| NPI: | 1922071141 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUMER | ||||||||
| FirstName: | MARSHALL | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3001 NW 49TH AVE | ||||||||
| Address2: | 307 | ||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544848990 | ||||||||
| FaxNumber: | 9547393732 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 NW 49TH AVE | ||||||||
| Address2: | 307 | ||||||||
| City: | LAUDERDALE LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333137266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544848990 | ||||||||
| FaxNumber: | 9547393732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 01/19/2011 | ||||||||
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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 | 207RP1001X | ME0016806 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 054909600 | 05 | FL | MEDICAID |