Healthcare Provider Details

I. General information

NPI: 1831184704
Provider Name (Legal Business Name): WILLIAM BRUCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEDICAL CENTER DR SUITE 201
PADUCAH KY
42003-7914
US

IV. Provider business mailing address

225 MEDICAL CENTER DR SUITE 201
PADUCAH KY
42003-7914
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4200
  • Fax: 270-441-4249
Mailing address:
  • Phone: 270-441-4200
  • Fax: 270-441-4249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20596
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: