Provider Demographics
NPI:1548263825
Name:BRAR, JUGROOP S (MD)
Entity type:Individual
Prefix:DR
First Name:JUGROOP
Middle Name:S
Last Name:BRAR
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 1:14961 W BELL RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3200
Mailing Address - Country:US
Mailing Address - Phone:623-242-9830
Mailing Address - Fax:623-243-6733
Practice Address - Street 1:14961 W BELL RD
Practice Address - Street 2:SUITE 175
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3200
Practice Address - Country:US
Practice Address - Phone:623-242-9830
Practice Address - Fax:623-243-6733
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34967207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114772Medicaid
AZZ115391Medicare PIN
G73389Medicare UPIN