Individual
MATTHEW BRUCKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9556 MANCHESTER ROAD, SAINT LOUIS, MO 63119-1313
(314) 961-2255
(314) 373-5757
Mailing address
9556 MANCHESTER ROAD, SAINT LOUIS, MO 63119-1313
(314) 961-2255
(314) 373-5757
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
051440
GA
207P00000X
Emergency Medicine Physician
Primary
2005029371
MO
207P00000X
Emergency Medicine Physician
MD071774L
PA
207P00000X
Emergency Medicine Physician
ME85875
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200520005
—
MO
Enumeration date
07/13/2006
Last updated
02/28/2011
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