Individual
DR. JON ELLIOTT DALE BRUBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-9355
(618) 256-7629
Mailing address
310 W LOSEY ST, SCOTT AFB, IL 62225-5250
(618) 256-9355
(618) 256-7629
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.165622
IL
208M00000X
Hospitalist Physician
036.165622
IL
Other
Enumeration date
01/20/2020
Last updated
07/26/2024
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