Bruce D Dragoo MD PC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

4301028716 Issued in MI

Legal business name

BRUCE D DRAGOO MD PC

Practice address

1000 E Paris Ave SE
Suite 225
Grand Rapids, MI 49546-3691

Phone

(616) 957-3643

Fax

(616) 957-0896

NPI assigned

Mar 14, 2007

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Freda Lyn Larkin

Title

Billing

Phone

(616) 957-3643

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1952434292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E PARIS AVE SE",
            "address_2": "SUITE 225",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463691",
            "telephone_number": "616-957-3643",
            "fax_number": "616-957-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E PARIS AVE SE",
            "address_2": "SUITE 225",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463691",
            "telephone_number": "616-957-3643",
            "fax_number": "616-957-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE D DRAGOO MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LARKIN",
        "authorized_official_first_name": "FREDA",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "616-957-3643"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": "4301028716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "4301028716",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083311",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC MI ID NUMBER",
            "identifier": "BD028716",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristine Marie Brownlow, PT
• Shana Goetting Broxup, PA
• Kim Marie Brubaker
• Russel Verne Brubaker, MD
• Bruce a. Jackson II, DDS, PLC
• Kelly Anne Bruch, RN, MSN, CNM
• Alec Ethan Bruchnak
• James Bruggink, PT
• Shannon Bruin
• Stefanie Bruinooge

• Durable Medical Equipment & Medical Supplies in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.

Verify at the official NPI Registry.