Individual
MARK THOMAS BRULTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 DOCTORS DR, SUITE 106, DOUGLAS, GA 31533-2201
(912) 384-3338
(912) 389-0979
Mailing address
200 DOCTORS DR, SUITE 106, DOUGLAS, GA 31533-2201
(912) 384-3338
(912) 389-0979
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
048490
GA
207R00000X
Internal Medicine Physician
Primary
048490
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000873441H
—
GA
05
—
000873441I
—
GA
05
—
0008734441F
—
GA
05
—
00873441A
—
GA
01
—
128214
PEACHSTATE
GA
01
—
478042
WELLCARE-DOUGLAS
GA
01
—
541189
WELLCARE-WILLACOOCHEE
GA
01
—
543782
WELLCARE-NICHOLLS
GA
01
—
GRP7301
MEDICARE GROUP #
GA
Enumeration date
09/13/2006
Last updated
12/08/2010
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us