Individual
CHARLES E BRUERD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
801 W MAPLE ST, FARMINGTON, NM 87401-5630
(505) 326-6400
(505) 326-4606
Mailing address
1515 E 20TH ST, SUITE A, FARMINGTON, NM 87401-9039
(505) 326-6400
(505) 326-4606
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
A1098-98
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050062432
RR MEDICARE
NM
01
—
10002369
LOVELACE HP
NM
01
—
201016403
PRESBYTERIAN HP
NM
05
—
34783369
—
CO
05
—
441410
—
AZ
01
—
NM004B05
BCBS
NM
05
—
T0130
—
UT
05
—
Z0728
—
NM
Enumeration date
02/10/2006
Last updated
01/05/2012
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