Healthcare Provider Details

I. General information

NPI: 1093802589
Provider Name (Legal Business Name): BRUCE RONALD CARLTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 ALAMO DR STE 2
VACAVILLE CA
95688-4243
US

IV. Provider business mailing address

292 ALAMO DR STE 2
VACAVILLE CA
95688-4243
US

V. Phone/Fax

Practice location:
  • Phone: 707-448-2218
  • Fax: 707-453-1602
Mailing address:
  • Phone: 707-448-2218
  • Fax: 707-453-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG22448
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: