Healthcare Provider Details

I. General information

NPI: 1407812340
Provider Name (Legal Business Name): BRUCE ELBERT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HMB CIRCLE
FRANKFORT KY
40601
US

IV. Provider business mailing address

PO BOX 4168
FRANKFORT KY
40601
US

V. Phone/Fax

Practice location:
  • Phone: 502-695-7725
  • Fax: 502-695-7848
Mailing address:
  • Phone: 502-223-5811
  • Fax: 502-227-7379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA527
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: