MEDICARE: DAVID A BRUCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	46946	MN
2	207L00000X	Anesthesiology Physician	MD00048205	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508831793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID A BRUCK MD

Provider Business Mailing Address
First Line	:	1229 MADISON ST
Second Line	:	SUITE 1440
City	:	SEATTLE
State	:	WA
Zip	:	98104-3586
Country	:	US
Telephone Number	:	206-625-0578
Fax Number	:	206-625-9184

Provider Business Practice Location Address
First Line	:	1229 MADISON ST
Second Line	:	SUITE 1440
City	:	SEATTLE
State	:	WA
Zip	:	98104-3586
Country	:	US
Telephone Number	:	206-625-0578
Fax Number	:	206-625-9184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/26/2011

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Directions to “ DAVID A BRUCK MD” Practice Location

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