Healthcare Provider Details

I. General information

NPI: 1558366047
Provider Name (Legal Business Name): BRUCE J DREYFUSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N 14TH ST STE 890
SAN JOSE CA
95112-6216
US

IV. Provider business mailing address

25 N 14TH ST STE 890
SAN JOSE CA
95112-6216
US

V. Phone/Fax

Practice location:
  • Phone: 408-288-6623
  • Fax: 408-288-6698
Mailing address:
  • Phone: 408-288-6623
  • Fax: 408-288-6698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberFAC52131
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG64297
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License NumberRHC142268
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: