MEDICARE: DR. BRUCE JEFFREY APPLEBAUM M.D.

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	2086S0127X	Trauma Surgery Physician	J3278	TX
2	208600000X	Surgery Physician	J3278	TX

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

General Provider Information

NPI Number	:	1902803679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE JEFFREY APPLEBAUM M.D.

Provider Business Mailing Address
First Line	:	14763 BIG OAK BAY RD
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75707-7307
Country	:	US
Telephone Number	:	915-474-4102
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 S FLEISHEL AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2041
Country	:	US
Telephone Number	:	903-606-5560
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/08/2024

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