MEDICARE: MR. BRUCE ALLEN HERR JR. CRNA

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	367500000X	Certified Registered Nurse Anesthetist	4704221887	MI
2	367500000X	Certified Registered Nurse Anesthetist	R235618	MD
3	367500000X	Certified Registered Nurse Anesthetist	0024182902	VA
4	367500000X	Certified Registered Nurse Anesthetist	RN1004845	DC

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	BH221887	OTHER	MI	BLUE CROSS OF MI

General Provider Information

NPI Number	:	1760469415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE ALLEN HERR JR. CRNA

Provider Business Mailing Address
First Line	:	4200 WISCONSIN AVE NW
Second Line	:	STE 106-152
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2143
Country	:	US
Telephone Number	:	734-735-5761
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 WISCONSIN AVE NW
Second Line	:	STE 106-152
City	:	WASHINGTON
State	:	DC
Zip	:	20016-2143
Country	:	US
Telephone Number	:	202-963-1703
Fax Number	:

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	05/22/2025

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