Provider Demographics
NPI:1649838038
Name:BRUSS, MARK HOWARD (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HOWARD
Last Name:BRUSS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 SEAGATE # 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-291-1420
Mailing Address - Fax:419-214-3841
Practice Address - Street 1:3316 NAVARRE AVE STE F
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3301
Practice Address - Country:US
Practice Address - Phone:419-291-1420
Practice Address - Fax:419-214-3841
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005981RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant