Individual
JACOB ROBERT LYNN BRUBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
17927 131ST ST E, BONNEY LAKE, WA 98391-7686
(206) 790-3890
Mailing address
3400 LATOUCHE ST, SUITE 100, ANCHORAGE, AK 99508-4208
(907) 561-1777
(907) 561-2157
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
—
—
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PO0012
—
AK
Enumeration date
08/10/2012
Last updated
12/02/2019
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