Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G40582 | CA |
NPI | 1144397084 |
---|---|
Provider Name | Richard D. Brumley |
First Address | Santa Ana, CA 92704-6948 |
Second Address | Santa Ana, CA 92704-6948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 05/06/2012 |