Healthcare Provider Details

I. General information

NPI: 1295711091
Provider Name (Legal Business Name): ROBERT NORWOOD BRUCE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 BOX 100 LRMC
APO AE
09180-0100
US

IV. Provider business mailing address

LRMC, CMR 402 BOX 100
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 314-486-7729
  • Fax:
Mailing address:
  • Phone: 314-486-7729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberOP00001318
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: