Provider Demographics
NPI:1356344626
Name:BRUGGEMAN, BRIAN B (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:B
Last Name:BRUGGEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14155 N. 83RD AVE
Mailing Address - Street 2:SUITE 147
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381
Mailing Address - Country:US
Mailing Address - Phone:602-230-2200
Mailing Address - Fax:208-535-4564
Practice Address - Street 1:14155 N. 83RD AVE
Practice Address - Street 2:SUITE 147
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-230-2200
Practice Address - Fax:208-535-4564
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2025-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM10264208200000X
WI83551208200000X
WI101550208200000X
NH22884208200000X
AZ31346208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1023267895Medicaid
AZ784422Medicaid
ID808217900Medicaid
AZ18032746OtherSTATE COMP FUND AZ
ID1023267895Medicaid
WI1356344626Medicaid
AZ31346OtherSTATE LICENSE AZ
AZ8607474153011OtherTAX ID
AZAZ0734420OtherBLUE CROSS BLUE SHIELD AZ
WY1023267895Medicaid
AZPOOOO4401OtherRAILROAD MEDICARE
AZ8640234OtherCIGNA
AZP784422Medicaid
AZP784422Medicaid
AZ18032746OtherSTATE COMP FUND AZ
AZH85609Medicare UPIN