Healthcare Provider Details

I. General information

NPI: 1083658363
Provider Name (Legal Business Name): BRUCE THUMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD
IRVINE CA
92618-2125
US

IV. Provider business mailing address

PO BOX 969096
SAN DIEGO CA
92196-9096
US

V. Phone/Fax

Practice location:
  • Phone: 949-341-3499
  • Fax: 949-788-0556
Mailing address:
  • Phone: 858-495-0971
  • Fax: 858-495-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG61341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: