Dr Jon Elliott Dale Brubaker, MD | |
310 W Losey St, Scott Afb, IL 62225-5250 | |
(618) 256-9355 | |
(618) 256-7629 |
Full Name | Dr Jon Elliott Dale Brubaker |
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Gender | Male |
Speciality | Internal Medicine |
Location | 310 W Losey St, Scott Afb, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1265062178 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208M00000X | Hospitalist | 036.165622 (Illinois) | Secondary |
207R00000X | Internal Medicine | 036.165622 (Illinois) | Primary |
Entity Name | Southern Illinois Healthcare Foundation, Inc. |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1013198712 PECOS PAC ID: 1456256874 Enrollment ID: O20031126000641 |
Mailing Address | Practice Location Address |
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Dr Jon Elliott Dale Brubaker, MD 310 W Losey St, Scott Afb, IL 62225-5250 Ph: (618) 256-9355 | Dr Jon Elliott Dale Brubaker, MD 310 W Losey St, Scott Afb, IL 62225-5250 Ph: (618) 256-9355 |
Dr. Adam Kirk Derrickson, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 310 W Losey St, Scott Afb, IL 62225 Phone: 618-256-7799 | |
Kenneth Paul Mcdonnell, M.D. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 203 W Losey St, Suite 1624, Scott Afb, IL 62225 Phone: 618-206-2225 | |
Assy Yacoub, D.O. Internal Medicine Medicare: Medicare Enrolled Practice Location: 310 W Losey St, Scott Afb, IL 62225 Phone: 618-256-3434 |