# HERMAN WALLACE BRUBAKER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1609870054
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD028694E | PA | Yes |

## Other

- **Enumeration date:** 06/13/2005
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000908788 | — | PA |
| 01 | — | 080086589 | RAILROAD MEDICARE | PA |
| 01 | — | 120420409 | DEPT OF LABOR | PA |
| 01 | — | 122715 | UNISON | PA |
| 01 | — | 1806901 | CAPITAL BLUECROSS | PA |
| 01 | — | 247728 | MAMSI | PA |
| 01 | — | 25-1716306 | DEVON | PA |
| 01 | — | 426224 | HEALTH AMERICA | PA |
| 01 | — | 4397945 | AETNA NON-HMO | PA |
| 01 | — | 666058 | FIRST HEALTH | PA |
| 01 | — | 842753 | AETNA HMO | PA |
| 01 | — | 867633 | MEDICARE GROUP \# | PA |
| 01 | — | BR426736 | HIGHMARK BLUE SHIELD | PA |
| 01 | — | MD028694E | LICENSE | PA |
| 01 | — | P006020 | GATEWAY | PA |