MEDICARE: BRUCE G HELLER 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	207Q00000X	Family Medicine Physician	A84653	CA

General Provider Information

NPI Number	:	1932194123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE G HELLER MD

Provider Business Mailing Address
First Line	:	2220 NORTHPOINT PKWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-7398
Country	:	US
Telephone Number	:	707-526-3180
Fax Number	:	707-528-2431

Provider Business Practice Location Address
First Line	:	2220 NORTHPOINT PKWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-7398
Country	:	US
Telephone Number	:	707-526-3180
Fax Number	:	707-528-2431

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	04/26/2013

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