MEDICARE: DR. MARK BRUCE 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	207P00000X	Emergency Medicine Physician	H8591	TX

General Provider Information

NPI Number	:	1669416871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BRUCE MD

Provider Business Mailing Address
First Line	:	861 SW 78TH AVE
Second Line	:	SUITE 100B
City	:	PLANTATION
State	:	FL
Zip	:	33324-3229
Country	:	US
Telephone Number	:	954-693-0000
Fax Number	:	954-693-0005

Provider Business Practice Location Address
First Line	:	1551 HIGHWAY 34 S
Second Line	:	EMERGENCY DEPARTMENT
City	:	TERRELL
State	:	TX
Zip	:	75160-4833
Country	:	US
Telephone Number	:	972-551-6860
Fax Number	:	972-551-6811

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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