Active NPI
Mary Louisa Brubaker, PA
- Family Medicine Physician
- Flagstaff, AZ
National Provider Identifier
1336117134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2368
- Practice address
- 2920 N 4TH St
Flagstaff, AZ 86004-1816 - Phone
- (928) 213-6121
- Fax
- (928) 213-6136
- NPI assigned
- Mar 9, 2006
- Last updated
- Aug 4, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 7108 | AZ | |
| Family Medicine Physician | 207Q00000X | 2368 | AZ | Primary |
Addresses
Primary practice location
2920 N 4TH St
Flagstaff, AZ 86004-1816
Mailing address
PO Box 3630
Flagstaff, AZ 86003-3630
Phone (928) 213-6121
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7108 | AZ | MD | Pharmacotherapy Pharmacist |
| 2368 | AZ | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217808000000",
"number": "1336117134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3630",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860033630",
"telephone_number": "928-213-6121",
"fax_number": "928-213-6136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2920 N 4TH ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860041816",
"telephone_number": "928-213-6121",
"fax_number": "928-213-6136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUBAKER",
"first_name": "MARY",
"middle_name": "LOUISA",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-09",
"last_updated": "2008-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "AZ",
"license": "7108",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "2368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.