Healthcare Provider Details

I. General information

NPI: 1669465191
Provider Name (Legal Business Name): BRUCE HENRY MCFALL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N BANCROFT PKWY SUITE 203
WILMINGTON DE
19805-2690
US

IV. Provider business mailing address

10 WATERWHEEL CIR
DOVER DE
19901-6262
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-2455
  • Fax: 302-652-2444
Mailing address:
  • Phone: 302-698-0299
  • Fax: 302-677-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number2760
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0008353
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: