Wallace John Bruder, M.D.

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

4301033897 Issued in MI

Practice address

4045 W Royal Dr
Traverse City, MI 49684-8965

Phone

(231) 935-0900

Fax

(231) 935-0308

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Munson Healthcare Grayling

  dba Prudenville Community Health Center

  • Rural Health Clinic/Center
  • Prudenville, MI
  • NPI 1144626052
  NPD (past)
• Munson Healthcare Grayling

  dba Roscommon Community Health Center

  • Family Medicine Physician
  • Roscommon, MI
  • NPI 1598131617
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296691200000",
    "number": "1396769220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-935-0900",
            "fax_number": "231-935-0308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-935-0900",
            "fax_number": "231-935-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUDER",
        "first_name": "WALLACE",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2011-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "4301033897",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103104985",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas A. Brown, D.D.S.
• Tracy Lynn Brown
• Ashley Browne
• Hope Broxterman, PHARMD
• Bruce G Douglass PHD PC
• Kersti Bruining, M.D.
• Bria L Brunette
• Elizabeth Garber Bruning, PH.D.
• John E Brunner, M.D.
• Kristin Leah Bryan, LPTA

• Orthopaedic Surgery Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Orthopaedic Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.