MEDICARE: BRUCE MAYER, MD PC

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	0101046065	VA

General Provider Information

NPI Number	:	1982620357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE MAYER, MD PC

Provider Business Mailing Address
First Line	:	7151 RICHMOND RD STE 403
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-7234
Country	:	US
Telephone Number	:	757-566-2045
Fax Number	:	757-741-2735

Provider Business Practice Location Address
First Line	:	7151 RICHMOND RD STE 403
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-7234
Country	:	US
Telephone Number	:	757-566-2045
Fax Number	:	757-741-2735

Authorized Official
Title or Position	:	MD
Name	:	DR. BRUCE MATTHEW MAYER
Credential	:	MD
Telephone Number	:	757-566-2045

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	02/05/2020

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